Background—: This study evaluated whether minority orthotopic heart transplant (OHT) recipients tend to be transplanted at worse performing centers. Methods and Results—: OHT recipients between 2000 and 2010 were identified in the United Network for Organ Sharing database and stratified by race. Center performance was evaluated using observed-to-expected mortality ratios that were calculated using validated indexes for recipient and donor risk in OHT. The primary outcome was 1-year post-OHT mortality. A total of 102 centers performed OHT in 18 085 patients. Blacks had higher unadjusted 1-year mortality, which was confirmed after risk adjustment. Blacks had increased risk-adjusted mortality at poor performing centers (observed-to-expected mortality ratio, >1.2; odds ratio, 1.37 [95% confidence interval, 1.12–1.69]; P =0.002) and a strong trend toward increased mortality at excellent performing centers (observed-to-expected mortality ratio, <0.8; odds ratio, 1.42 [95% confidence interval, 0.99–2.02]; P =0.06). A higher proportion of blacks were treated at centers with higher-than-expected mortality (56.4% versus 47.1% whites versus 48.1% Hispanics; P <0.001), a finding that persisted after adjusting for insurance type and highest education level. In addition, there was a positive correlation between the percentage of blacks and observed-to-expected mortality ratios at the center level ( r =0.32; P =0.001). In multivariable analysis incorporating immunologic and socioeconomic variables, there was no clear dominant source for the disparities in outcomes of OHT between races. Conclusions—: Blacks have a propensity to be transplanted at worse performing centers; however, center effect alone does not explain the mortality difference between ethnicities. Although referral of minorities to better performing centers would improve absolute survival, it would not likely eliminate the racial disparities that exist in OHT outcomes.

Donor selection in heart transplantation

The use of iron-coated pumice (ICP) in heterogeneous catalytic ozonation significantly enhanced the removal efficiency of natural organic matters (NOMs) in water, due to the synergistic effect of hybrid processes when compared to sole ozonation and adsorption. Multiple characterization analyses (BET, TEM, XRD, DLS, FT-IR, and pH_PZC) were employed for a systematic investigation of the catalyst surface properties. This analysis indicated that the ICP crystal structure was α-FeOOH, the surface hydroxyl group of ICP was significantly increased after coating, the particle size of ICP was about 200–250 nm, the BET surface area of ICP was about 10.56 m² g⁻¹, the pH_PZC value of ICP was about 7.13, and that enhancement by iron loading was observed in the FT-IR spectra. The contribution of surface adsorption, hydroxyl radicals, and sole ozonation to catalytic ozonation was determined as 21.29%, 66.22%, and 12.49%, respectively. The reaction kinetic analysis with tert-Butyl alcohol (TBA) was used as a radical scavenger, confirming that surface ferrous iron loading promoted the role of the hydroxyl radicals. The phosphate was used as an inorganic probe, and significantly inhibited the removal efficiency of catalytic NOM ozonation. This is an indication that the reactions which occur are more dominant in the solution phase.

Cardiogenic shock (CS) continues to have high mortality and morbidity despite advances in pharmacological, mechanical, and reperfusion approaches to treatment. When CS is refractory to medical therapy, percutaneous mechanical circulatory support (MCS) should be considered. Acute MCS devices, ranging from intra-aortic balloon pumps (IABPs) to percutaneous temporary ventricular assist devices (VAD) to extracorporeal membrane oxygenation (ECMO), can aid, restore, or maintain appropriate tissue perfusion before the development of irreversible end-organ damage. Technology has improved patient survival to recovery from CS, but in patients whom cardiac recovery does not occur, acute MCS can be effectively utilized as a bridge to long-term MCS devices and/or heart transplantation. Heart transplantation has been limited by donor heart availability, leading to a greater role of left ventricular assist device (LVAD) support. In patients with biventricular failure that are ineligible for LVAD implantation, further advancements in the total artificial heart (TAH) may allow for improved survival compared to medical therapy alone. In this review, we discuss the current state of acute and durable MCS, ongoing advances in LVADs and TAH devices, improved methods of durable MCS implantation and patient selection, and future MCS developments in this dynamic field that may allow for optimization of HF treatment.