Heart Failure & Transplant Update

Podcast Transcript

Announcer:

Welcome to Cleveland Clinic Cardiac Consult, brought to you by the Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute at Cleveland Clinic.

Michael Zhen-Yu Tong, MD:

Good morning. I am delighted to share with you our 2022 experience for the Kaufman Center for Heart Failure Treatment and Recovery. 2022 was another fantastic year for our program. Combined, we performed 142 LVAD and heart transplants, which places us third in the nation. What really distinguishes us is the level of complexity and our survival. If you compare the top 10 programs in the nation, we have the second-highest level of complexity and risk, yet we have the third-best survival. If you have your LVAD or transplant done at the Cleveland Clinic, you have a 38 percent lower risk of mortality compared to our peers.

The HeartMate 3 continues to be a workhorse of a device. It is very reliable and very durable, and in 2022, we will implement 72 HeartMate 3 devices, which also places us third nationally. 2023, we're already off to a fast start, and we are expected to reach around 100 cases of HeartMate 3, and our outcomes are just outstanding. In 2022, among the 72 implants, we only had one death, which gives us the best outcomes among the top 10 programs, which is absolutely incredible given the complexity of these cases and the morbidity of these cases going into the operating room.

Speaking of morbidity, stroke has always been an Achilles heel of LVAD technology, and it's something that we've spent a tremendous amount of effort to try to reduce. And I'm happy to report that currently our 24-month stroke risk is now down to 8 percent, which is down from 20 percent just a few years ago. In fact, if you look beyond the first 30 days, the annual risk of stroke in a patient with LVAD is only about 2.5 percent, which in essence is the same as if you had atrial fibrillation. For patients with acute cardiogenic shock, we have revamped our Center for Shock and Circulatory Support, and we have a system-wide hub and spoke network to provide cardiogenic shock support services to all Cleveland Clinic hospitals and other collaborating regional hospitals. We have a shock team that can be quickly activated to provide advice on the phone, and to initiate transfer in a timely fashion for patients with acute cardiogenic shock. And in 2022, through the shock team, we implanted 128 VA-ECMOs or VAV-ECMOs, as well as 113 Impella devices.

The heart transplant program remains the crown jewel of our heart failure program, and to date, we have performed 2,176 heart transplants, which is amongst the leaders anywhere in the world. 2022, we performed 66 heart transplants, and in 2023, we are also off to a fast start, and we are poised to have the busiest numbers in the last decade.

As a team, we have strategized on how to decrease the wait times for our recipients, and we have embarked on many strategies to increase the number of donors that are available, including having a hep C donor program, a COVID positive donor program. As we recognize the Omicron strain does not affect the heart, we are also utilizing more hearts from donors that have older age and select donors who have pristine hearts. We also have ex vivo profusion technology now that allows us to travel 2,500 miles to retrieve hearts, which in essence allows us to go anywhere in the continental US, Puerto Rico and Alaska. And most importantly, in the last year, we've also started our DCD program, which is donation after cardiac death. Previously, we only take hearts from those donors with brain death, but now the DCD program allows us to take hearts from donors that have had cardiac death. And we use two technologies, one is a portable ECMO circuit, which we will travel to donor hospitals, when a donor pronounced, we will put the donor on ECMO to resuscitate their hearts and utilize their hearts. The second technology is the OCS device, which allows us to procure hearts from somebody who has cardiac death, use the heart, hook it up to a circuit, and allow the heart to pump and recover as it travels back to Cleveland for us to utilize.

If you look at our outcomes for heart transplantation, it is excellent. At one year, we have a 40 percent less risk of graft failure compared to the national average, and at three years, we have a 49 percent lower risk of graft failure. In fact, amongst the big programs, we have the best three-year outcome, which is at 94 percent three-year survival. In fact, our three-year survival is better than the one-year survival of most large programs, and far better than the 86 percent three-year national average.

One special population that I also want to highlight are the patients with right heart failure that have a condition called chronic thromboembolic pulmonary hypertension, or CTEF, and we perform an operation called the pulmonary endarterectomy. And 2022 was our busiest year in this program, we performed 52 pulmonary endarterectomies, which also places us in the top three nationally. Our mortality rate over the last few years is 1.5 percent, which is far below the 7 percent national average, and the 5 percent mortality is to be considered a center of excellence. Most importantly, for these patients, 90 percent of these patients are able to come off of their pulmonary vasodilator therapy, which is a drug that not only has high morbidity, but also costs about 100,000 dollars a year.

And finally, four weeks ago, we had our system-wide Kaufman Center Heart Failure Retreat, where we strategized on how to continue to build upon our mission to be leaders in treatment for advanced heart failure patients and strive for excellence in innovation and research. Through this initiative, we will continue to lead heart failure treatments for this very sick group of patients. We call ourselves, not the heart failure team, but the heart recovery team, because there's no better place in the world for you to have your heart recovered if you are somebody that has heart failure. Thank you very much.

Announcer:

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