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Life-long anticoagulation is required for patients following pulmonary thromboendarterectomy (PTE). Warfarin is the default anticoagulant; however, many patients request direct oral anticoagulants (DOACs) as they do not require monitoring or dietary changes. There is limited data on the safety and efficacy of DOACs following PTE, and the aim of this study is to better understand the bleeding and clotting risks in patients taking the two classes of medications after PTE in a non-trial setting. To better understand real-world anticoagulation prescribing patterns and their potential implications following PTE, we retrospectively identified all patients who underwent PTE at our institution since July 2011 and determined their post-discharge anticoagulation regimen and the occurrence of complications using a standardized telephone questionnaire. Comparisons were made using Fisher's exact text. 246 patients underwent a PTE at our institution after July 2011; our hospital electronic medical record indicated 33 (13%) died since their index operation. Of the 213 remaining, 72 (34%) patients were successfully contacted and 51 (23%) agreed to participate in the questionnaire for a response rate of 24%. The mean time from the index PTE for these 51 patients was 5.2 years +/- 3.2 years. Table 1 displays the results of the questionnaire. Nine patients (18%) who were discharged on warfarin switched to a DOAC. Notably, all 3 patients with a recurrent pulmonary embolism (PE) after PTE had been switched from warfarin to a DOAC prior to the PE (P = 0.04). Each required hospitalization (P = 0.04). There was no difference in bleeding complications between the groups. Patients transitioned from warfarin to DOACs were more likely to experience recurrent PE and require in-hospital PE treatment. Larger studies assessing the use of DOACs in this population are needed to determine effectiveness and safety. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) causes a profound systemic inflammatory response and the transmissibility was unknown early in the pandemic; consequently, transplant centers were hesitant to utilize organs from COVID-19+ donors. This study aims to analyze short and medium-term outcomes in recipients of hearts from COVID-19+ donors. The Organ Procurement and Transplantation Network database was queried for all heart transplant recipients between January 1, 2020 and December 31, 2021. Recipients of COVID-19+ donor hearts were compared to recipients of COVID-19- donor hearts. Pediatric recipients, multiorgan transplants, donors without COVID-19 testing, and recipients allocated under the old heart allocation system were excluded. One to three propensity score matching was used to match COVID+ donor heart recipients to COVID- donor heart recipients. Over the study period, 4,621 heart transplant recipients met inclusion-exclusion criteria, including 62 recipients of COVID+ donor hearts. After matching on pre-transplant recipient and donor characteristics, the 59 COVID+ donor heart recipients were matched to 177 COVID- donor heart recipients. Baseline characteristics were similar following matching. Thirty-day survival was similar between groups (COVID- 95.5% vs. COVID+ 100.0%, log rank p=0.10) as was six-month survival (COVID- 93.2% vs. COVID+ 98.3%, log rank p=0.15; Figure 1). National COVID+ donor heart usage varied by region, with region 11 transplanting the largest proportion of COVID+ hearts [11/62 (17.7%)] and region 10 transplanting the least [1/62 (1.64%)]. COVID+ heart utilization per region was greatest in region 1 [7/249 (2.8%)] and least in region 10 [1/384 (0.26%)]. Thirty-day and six-month survival in recipients of COVID+ donor hearts is similar to that of COVID- donor hearts. These data should encourage increased utilization of COVID+ donor hearts. Further analyses are needed to determine if long-term outcomes are equivalent between groups. [ABSTRACT FROM AUTHOR]

Demand for donor hearts persistently outstrips supply. To expand the donor pool, in the past four years, US centers have transplanted hearts procured from donors after circulatory death (DCD). DCD heart recipients frequently exhibit early, clinically significant, but reversible right ventricular dysfunction (RVD), but little is known about how this impacts post-transplant renal function. We evaluated whether DCD transplantation is associated with early renal dysfunction as compared to recipients receiving standard of care (SOC) hearts donated after brain death (DBD). All patients at a single center who were not on dialysis and underwent single-organ cardiac transplantation from April 2016 to August 2022 were included. Renal metrics collected included final pre-transplantation creatinine and peak creatinine within seven days after transplantation; these were converted to eGFR using the CKD-Epi 2021 Race-Free GFR equation. Acute kidney injury (AKI) was defined as a 1.5-fold rise in creatinine within seven days. RA pressure was measured via right heart catheterization on day seven after transplant. Data were statistically analyzed with two-tailed t-tests, chi-squared tests, and Pearson's correlation coefficients, as appropriate. 228 patients (171 SOC and 57 DCD) were included. Baseline characteristics were similar between groups. Nadir eGFR in the first week post-transplantation was similar between DCD and SOC (50.4 ± 28.0 mL/min vs 48.1 ± 25.8 mL/min; p=0.58), as were rates of AKI (49.1% vs 46.2%; p=0.92) and use of CVVH (7.0% vs 5.3%; p=0.89). DCD patients had higher RA pressures on day seven post-transplant (10.0 ± 4.2 mmHg vs 8.2 ± 4.7 mmHg for SOC; p=0.01); the inverse relationship between RA pressures and nadir post-transplantation eGFR in DCD patients was not significant (r=-0.25; p=0.07). While transplantation using DCD hearts is associated with early RVD, no adverse impact on early renal outcomes compared to SOC recipients was observed. [ABSTRACT FROM AUTHOR]