March 5, 2019 e1 WRITING GROUP MEMBERS Emelia J. Benjamin, MD, ScM, FAHA, Chair Paul Muntner, PhD, MHS, FAHA, Vice Chair Alvaro Alonso, MD, PhD, FAHA Marcio S. Bittencourt, MD, PhD, MPH Clifton W. Callaway, MD, FAHA April P. Carson, PhD, MSPH, FAHA Alanna M. Chamberlain, PhD Alexander R. Chang, MD, MS Susan Cheng, MD, MMSc, MPH, FAHA Sandeep R. Das, MD, MPH, MBA, FAHA Francesca N. Delling, MD, MPH Luc Djousse, MD, ScD, MPH Mitchell S.V. Elkind, MD, MS, FAHA Jane F. Ferguson, PhD, FAHA Myriam Fornage, PhD, FAHA Lori Chaffin Jordan, MD, PhD, FAHA Sadiya S. Khan, MD, MSc Brett M. Kissela, MD, MS Kristen L. Knutson, PhD Tak W. Kwan, MD, FAHA Daniel T. Lackland, DrPH, FAHA Tené T. Lewis, PhD Judith H. Lichtman, PhD, MPH, FAHA Chris T. Longenecker, MD Matthew Shane Loop, PhD Pamela L. Lutsey, PhD, MPH, FAHA Seth S. Martin, MD, MHS, FAHA Kunihiro Matsushita, MD, PhD, FAHA Andrew E. Moran, MD, MPH, FAHA Michael E. Mussolino, PhD, FAHA Martin O’Flaherty, MD, MSc, PhD Ambarish Pandey, MD, MSCS Amanda M. Perak, MD, MS Wayne D. Rosamond, PhD, MS, FAHA Gregory A. Roth, MD, MPH, FAHA Uchechukwu K.A. Sampson, MD, MBA, MPH, FAHA Gary M. Satou, MD, FAHA Emily B. Schroeder, MD, PhD, FAHA Svati H. Shah, MD, MHS, FAHA Nicole L. Spartano, PhD Andrew Stokes, PhD David L. Tirschwell, MD, MS, MSc, FAHA Connie W. Tsao, MD, MPH, Vice Chair Elect Mintu P. Turakhia, MD, MAS, FAHA Lisa B. VanWagner, MD, MSc, FAST John T. Wilkins, MD, MS, FAHA Sally S. Wong, PhD, RD, CDN, FAHA Salim S. Virani, MD, PhD, FAHA, Chair Elect On behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee

Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association

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/pdf/acc-aha-2005-guideline-update-for-the-diagnosis-and-4hik65ngbe.pdf

ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure).

Mariell Jessup, MD, FACC, FAHA, Chair [*][1]

William T. Abraham, MD, FACC, FAHA[†][2]

Donald E. Casey, MD, MPH, MBA[‡][3]

Arthur M. Feldman, MD, PhD, FACC, FAHA[§][4]

Gary S. Francis, MD, FACC, FAHA[§][4]

Theodore G. Ganiats, MD[∥][5]

Marvin A. Konstam, MD, FACC[¶][6]

Donna M.

/pdf/2009-focused-update-incorporated-into-the-acc-aha-2005-3z9lhvyqwq.pdf

2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation

During the past decade, catheter ablation of atrial fibrillation (AF) has evolved rapidly from an investigational procedure to its current status as a commonly performed ablation procedure in many major hospitals throughout the world. Surgical ablation of AF, using either standard or minimally invasive techniques, is also performed in many major hospitals throughout the world.

In 2007, an initial Consensus Statement on Catheter and Surgical AF Ablation was developed as a joint effort of the Heart Rhythm Society, the European Heart Rhythm Association, and the European Cardiac Arrhythmia Society.1 The 2007 document was also developed in collaboration with the Society of Thoracic Surgeons and the American College of Cardiology. Since the publication of the 2007 document, there has been much learned about AF ablation, and the indications for these procedures have changed. Therefore the purpose of this 2012 Consensus Statement is to provide a state-of-the-art review of the field of catheter and surgical ablation of AF and to report the findings of a Task Force, convened by the Heart Rhythm Society, the European Heart Rhythm Association, and the European Cardiac Arrhythmia Society and charged with defining the indications, techniques, and outcomes of this procedure. Included within this document are recommendations pertinent to the design of clinical trials in the field of AF ablation, including definitions relevant to this topic.

This statement summarizes the opinion of the Task Force members based on an extensive literature review as well as their own experience. It is directed to all health care professionals who are involved in the care of patients with AF, particularly those who are undergoing, or are being considered for, catheter or surgical ablation procedures for AF. This statement is not intended to recommend or promote catheter ablation of AF. Rather the ultimate judgment regarding care of a particular patient …

2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design

Palliated hypoplastic left heart syndrome patients experience superior waitlist and comparable post-heart transplant survival to non-single ventricle congenital heart disease patients.

Commentary: Cost of Doing Business.

Commentary: The environment matters: The effects of passive circulation are not quickly reversed by a change of heart.

Purpose Many have discussed the perils of “limping to transplant” & have identified risk factors associated with poor heart transplant (HTx) survival. We sought to determine the effect of total parenteral nutrition (TPN)-dependence & paralytics on HTx survival. Methods UNOS & PHIS data were used to identify infants listed for HTx (1996-2020) on mechanical ventilation (MV; ≥2 consecutive days pre-HTx), paralytics (insurance-charge on ≥3/5 days pre-HTx), &/or TPN-dependent (insurance-charge for TPN on ≥3/5 days pre-HTx; no charges for oral nutrition on 5/5 days). Results 1,425 patients were identified: MV (n=355), paralytics (n=132), and/or TPN (n=351). DCM was more common in those on MV & paralytics, whereas TPN patients had more organ dysfunction & ECMO (p<0.01 for all; Table). 1-year mortality was independently predicted by MV (HR 1.5 (95% CI 1.1-2.0), p=0.01), paralytics (1.8 (1.2-2.8), p<0.01), & TPN (1.6 (1.2-2.2), p<0.01). Requirement for all three was the greatest predictor of mortality (2.3 (1.2-4.4), p<0.01), whereas requirement of none was protective (0.6 (1.2-2.2), p<0.01). As mutually exclusive groups, MV did not independently predict mortality compared to no-support (1.4 (0.9-2.3), p=0.14) or all others (0.7 (0.7-1.7), p=0.69) but all other combinations of TPN, MV, & paralytics were predictive of mortality (p≤0.03 for all; Figure). Conclusion Paralytics &/or TPN at transplant independently predicted mortality in infants following HTx. Surprisingly, MV alone was not predictive, although over half of patients on MV were also on paralytics or TPN. This study demonstrates the complexity of what it means to “limp to transplant.” Many have discussed the perils of “limping to transplant” & have identified risk factors associated with poor heart transplant (HTx) survival. We sought to determine the effect of total parenteral nutrition (TPN)-dependence & paralytics on HTx survival. UNOS & PHIS data were used to identify infants listed for HTx (1996-2020) on mechanical ventilation (MV; ≥2 consecutive days pre-HTx), paralytics (insurance-charge on ≥3/5 days pre-HTx), &/or TPN-dependent (insurance-charge for TPN on ≥3/5 days pre-HTx; no charges for oral nutrition on 5/5 days). 1,425 patients were identified: MV (n=355), paralytics (n=132), and/or TPN (n=351). DCM was more common in those on MV & paralytics, whereas TPN patients had more organ dysfunction & ECMO (p<0.01 for all; Table). 1-year mortality was independently predicted by MV (HR 1.5 (95% CI 1.1-2.0), p=0.01), paralytics (1.8 (1.2-2.8), p<0.01), & TPN (1.6 (1.2-2.2), p<0.01). Requirement for all three was the greatest predictor of mortality (2.3 (1.2-4.4), p<0.01), whereas requirement of none was protective (0.6 (1.2-2.2), p<0.01). As mutually exclusive groups, MV did not independently predict mortality compared to no-support (1.4 (0.9-2.3), p=0.14) or all others (0.7 (0.7-1.7), p=0.69) but all other combinations of TPN, MV, & paralytics were predictive of mortality (p≤0.03 for all; Figure). Paralytics &/or TPN at transplant independently predicted mortality in infants following HTx. Surprisingly, MV alone was not predictive, although over half of patients on MV were also on paralytics or TPN. This study demonstrates the complexity of what it means to “limp to transplant.” 

Paralytics and Total Parenteral Nutrition Predict Post-Heart Transplant Mortality in Infants

Purpose Both ventricular assist devices (VADs) and inotropes are feasible modalities used to bridge children to heart transplant (HT) in the outpatient setting. However, it is unclear which modality, if either, yields superior functional status at time of HT and post-transplant survival (PTS). Methods The United Network for Organ Sharing (UNOS) database was used to identify patients (age ≤18 & >25 kg) who were listed for HT in 2012-2020 and were admitted from outpatient setting for HT. Patients were grouped as (a) inotrope only, (b) VAD only, (c) neither at HT. Primary outcome of interest included no-to-mild functional limitation at HT (Performance Scale >70%) and PTS. Results A total of 691 patients were included: 196 (28%) VAD-only, 168 (24%) inotrope only, 327 (47%) neither. Patients on VAD were heavier, more likely to be male, and more likely to have dilated cardiomyopathy than the other groups. Patients were more likely to be bridged on inotrope in the Midwest; conversely, they were more likely to be bridged on VAD in the West. Patients with VAD-only had superior functional status at HT (Table). Overall, PTS in VAD-only patients was comparable to patients with no support (p=0.266) and comparable to inotrope-only (p=0.279). VAD-only patients showed better 2-year conditional survival, compared to inotropes-only (p=0.05) (Figure). Conclusion As expected, short term outcomes for pediatric patients bridged to HT in the outpatient setting with VAD or inotropes is excellent. However, compared to outpatients bridged to HTx on inotropes, outpatient VAD support allowed for better clinical status at HT and superior long-term transplant survival. Both ventricular assist devices (VADs) and inotropes are feasible modalities used to bridge children to heart transplant (HT) in the outpatient setting. However, it is unclear which modality, if either, yields superior functional status at time of HT and post-transplant survival (PTS). The United Network for Organ Sharing (UNOS) database was used to identify patients (age ≤18 & >25 kg) who were listed for HT in 2012-2020 and were admitted from outpatient setting for HT. Patients were grouped as (a) inotrope only, (b) VAD only, (c) neither at HT. Primary outcome of interest included no-to-mild functional limitation at HT (Performance Scale >70%) and PTS. A total of 691 patients were included: 196 (28%) VAD-only, 168 (24%) inotrope only, 327 (47%) neither. Patients on VAD were heavier, more likely to be male, and more likely to have dilated cardiomyopathy than the other groups. Patients were more likely to be bridged on inotrope in the Midwest; conversely, they were more likely to be bridged on VAD in the West. Patients with VAD-only had superior functional status at HT (Table). Overall, PTS in VAD-only patients was comparable to patients with no support (p=0.266) and comparable to inotrope-only (p=0.279). VAD-only patients showed better 2-year conditional survival, compared to inotropes-only (p=0.05) (Figure). As expected, short term outcomes for pediatric patients bridged to HT in the outpatient setting with VAD or inotropes is excellent. However, compared to outpatients bridged to HTx on inotropes, outpatient VAD support allowed for better clinical status at HT and superior long-term transplant survival. 

David L.S. Morales

Papers

Palliated hypoplastic left heart syndrome patients experience superior waitlist and comparable post-heart transplant survival to non-single ventricle congenital heart disease patients.

Commentary: Cost of Doing Business.

Commentary: The environment matters: The effects of passive circulation are not quickly reversed by a change of heart.

Paralytics and Total Parenteral Nutrition Predict Post-Heart Transplant Mortality in Infants

Time to Reconsider Bridging Older Children on Outpatient Inotrope in an Era of Outpatient VADs