Advances in the Care of Stage D Heart Failure: LVAD/Transplant

By Sonia Garg, M.D.
Assistant Professor of Internal Medicine

I was pleased to moderate an oral abstract session in which researchers from across the country presented their work in advanced heart failure therapies. As background, for many patients with advanced heart failure, viable treatment options include implantation of a left ventricular assist device (LVAD) and, for a smaller subset of patients, heart transplantation, with median survival now exceeding 10 years.

Two of the abstracts addressed some of the major complications of LVADs, including stroke and GI bleeding. Dr. David Markham presented the two-year outcome data of the ENDURANCE supplemental trial, which demonstrated similar rates of stroke in patients with an HVAD and HeartMate II (two types of LVADs) and reiterated the importance of blood pressure control in reducing stroke in patients with an HVAD. The next abstract described low levels of butyrate-producing microbes and an associated lower concentration of butyrate in the stool of LVAD patients with GI bleeding. While butyrate has been identified to inhibit angiogenesis, further study is needed to understand the mechanisms involved in these findings.

The remaining presentations centered around heart transplantation. One of the abstracts showed that using predicted heart mass (rather than height and weight) to guide size-matching between the donor and the recipi­ent could allow for improved donor utilization because fewer organs would be turned down for inappropriate size.

Finally, two of the abstracts addressed important complications after cardiac transplan­tation, including chronic kidney disease and malignancies. A group led by Dr. Naveen Pereira raised the notion of using genotyping to identify genetic variations that are associated with the development of kidney dysfunction after transplant. Multicenter collaboration is needed for further study and validation of the group’s findings. Dr. Pereira’s group also reported that changing the type of immunosuppression after transplant was associated with a reduction in malignancies, namely post-transplant lympho­proliferative disorder (PTLD). Prospective study in this area would help guide standardization in post-transplant immunosuppression.