IMPORTANCEThe US heart allocation policy was changed on October 18, 2018. The association of this change with recipient and donor selection and outcomes remains to be elucidated.OBJECTIVE To evaluate changes in patient characteristics, wait list outcomes, and posttransplant outcomes after the recent allocation policy change in heart transplant. DESIGN, SETTING, AND PARTICIPANTSIn this cohort study, all 15 631 adults undergoing heart transplants, excluding multiorgan transplants, in the US as identified by the United Network for Organ Sharing multicenter, national registry were reviewed. Patients were stratified according to prepolicy change (October 1, 2015, to October 1, 2018) and postpolicy change (October 18, 2018 or after). Follow-up data were available through March 31, 2020.EXPOSURES Heart transplants after the policy change. MAIN OUTCOMES AND MEASURESCompeting risk regression for wait list outcomes was performed. Posttransplant survival was compared using the Kaplan-Meier method, and risk adjustment was performed using multivariable Cox proportional hazards regression analysis. RESULTSIn this cohort study, of the 15 631 patients undergoing transplant, 10 671 (mean [SD] age, 53.1 [12.7] years; 7823 [73.3%] male) were wait listed before and 4960 (mean [SD] age, 52.7 [13.0] years; 3610 [72.8%] male) were wait listed after the policy change. Competing risk regression demonstrated reduced likelihood of mortality or deterioration (subhazard ratio [SHR], 0.60; 95% CI, 0.52-0.69; P < .001), increased likelihood of transplant (SHR, 1.38; 95% CI, 1.32-1.45; P < .001), and reduced likelihood of recovery (SHR, 0.54; 95% CI, 0.40-0.73; P < .001) for wait listed patients after the policy change. A total of 6078 patients underwent transplant before and 2801 after the policy change. Notable changes after the policy change included higher frequency of bridging with temporary mechanical circulatory support and lower frequency of bridging with durable left ventricular assist devices. Posttransplant survival was reduced after the policy change (1-year: 92.1% vs 87.5%; log-rank P < .001), a finding that persisted after risk adjustment (HR, 1.29; 95% CI, 1.07-1.55; P = .008).CONCLUSIONS AND RELEVANCE Substantial changes have occurred in adult heart transplant in the US after the policy change in October 2018. Wait list outcomes have improved, although posttransplant survival has decreased. These data confirm findings from earlier preliminary analyses and demonstrate that these trends have persisted to 1-year follow-up, underscoring the importance of continued reevaluation of the new heart allocation policy.

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Background This study evaluated the impact of hepatitis C–positive ( HCV +) donors on outcomes of heart transplantation in the United States. Methods and Results Adults undergoing isolated heart transplantation in the United States between January 1, 2016, and December 31, 2018, were included. The primary outcome was 1‐year post‐transplant survival. Multivariable Cox regression and 2:1 propensity matching were used to compare outcomes between transplants with HCV + and hepatitis C–negative ( HCV −) donors. A subanalysis was performed to evaluate the impact of nucleic acid amplification test positivity on outcomes. Of 7889 isolated heart transplants performed during the study period, 343 (4.4%) used HCV + donors. Overall unadjusted 1‐year posttransplant survival was not statistically different between HCV − versus HCV + donors (91.1% versus 90.2%; P =0.86), a finding that persisted after risk adjustment (hazard ratio, 1.05; 95% CI, 0.70–1.58; P =0.80). Propensity matching resulted in 675 well‐balanced patients (437 HCV − and 238 HCV +). Overall 1‐year posttransplant survival was not statistically different in propensity‐matched analysis (89.8% HCV − versus 89.2% HCV +; P =0.88). Rates of 1‐year drug‐treated rejection (21.1% versus 22.1%; P =0.84), postoperative dialysis (11.4% versus 14.7%; P =0.22), and stroke (4.6% versus 2.1%; P =0.10) were also not statistically different between HCV − and HCV + groups, respectively. Outcomes were not statistically different between nucleic acid amplification test–negative and nucleic acid amplification test–positive HCV + donors. Conclusions Adult heart transplants using HCV + donors, including those that are nucleic acid amplification test positive, can be performed without an adverse impact on 1‐year survival. Wider implementation of protocols for using HCV + donors and an assessment of longer‐term outcomes including seroconversion rates will be important in maximizing the effect of HCV + donors on national donor shortages.

We applied the sensitive RIFLE criteria to examine AKI in patients undergoing elective aortic hemiarch replacement for aneurysmal disease. Baseline renal dysfunction, lower ejection fraction, and longer CPB time are independent predictors of AKI. Compared with DHCA/RCP, our data suggest that an MHCA/ACP cerebral protection strategy does not appear to be associated with worse postoperative renal outcomes.

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Aortic graft prostheses are susceptible to infection that can have catastrophic consequences with an operative mortality of nearly 50%. Management options include graft excision and replacement, aortic re-routing, and graft preservation techniques. This review summarizes the management of thoracic aortic graft infections.

Baseline TAPSE/PASP ratio is associated with all-cause mortality in TAVI patients as it evaluates RV systolic performance at a given degree of afterload. Incorporation of right-side unit into the risk stratification may improve optimal selection of patients for TAVI.