Jonathan N. Menachem

Successful cardiac transplantation outcomes in patients with adult congenital heart disease

Objectives The purpose of our study is (1) to characterise patients with congenital heart disease undergoing heart transplantation by adult cardiac surgeons in a large academic medical centre and (2) to describe successful outcomes associated with our multidisciplinary approach to the evaluation and treatment of adults with congenital heart disease (ACHD) undergoing orthotopic heart transplantation (OHT). Background Heart failure is the leading cause of death in patients with ACHD leading to increasing referrals for OHT. Methods The Penn Congenital Transplant Database comprises a cohort of patients with ACHD who underwent OHT between March 2010 and April 2016. We performed a retrospective cohort study of the 20 consecutive patients. Original cardiac diagnoses include single ventricle palliated with Fontan (n=8), dextro-transposition of the great arteries after atrial switch (n=4), tetralogy of Fallot (n=4), pulmonary atresia (n=1), Ebstein anomaly (n=1), unrepaired ventricular septal defect (n=1) and Noonan syndrome with coarctation of the aorta (n=1). Results Eight patients required pretransplant inotropes and two required pretransplant mechanical support. Nine patients underwent heart–liver transplant and three underwent heart–lung transplant. Three patients required postoperative mechanical circulatory support. Patients were followed for an average of 38 months as of April 2016, with 100% survival at 30 days and 1 year and 94% overall survival (19/20 patients). Conclusions ACHD–OHT patients require highly specialised, complex and multidisciplinary healthcare. The success of our programme is attributed to using team-based, patient-centred care including our multidisciplinary staff and specialists across programmes and departments.

Advanced Heart Failure in the ACHD Population: Finding the Fellows’ Role in a Growing Field

“By failing to prepare, you are preparing to fail.”—Benjamin Franklin [(1)][1] Preparation for every scenario in the rapidly changing field of cardiovascular medicine may not be possible. However, flexibility and a proactive approach to clinical training provides fellows with the best

RVOT-VTI/PASP: A NOVEL NON-INVASIVE METRIC OF PULMONARY ARTERIAL COMPLIANCE AND DIASTOLIC PRESSURE GRADIENT STATUS IN HEART FAILURE WITH PRESERVED EJECTION FRACTION

Background: Pulmonary hypertension (PH) due to heart failure with preserved ejection fraction (HFpEF) is a leading cause of PH. Within this population, the diastolic pressure gradient (DPG) distinguishes those with combined post- and pre-capillary PH (DPG ≥7 mm Hg; CpcPH), and isolated post-