1 00:00:05,235 --> 00:00:07,285 - This is the Becker's Healthcare Podcast, created 2 00:00:07,285 --> 00:00:08,445 by the team of Becker's Healthcare, 3 00:00:08,605 --> 00:00:10,325 a multimedia company devoted to the people 4 00:00:10,345 --> 00:00:11,645 who power us healthcare. 5 00:00:11,915 --> 00:00:14,765 Four new 15 minute episodes are released daily containing 6 00:00:14,925 --> 00:00:16,685 industry news analysis and thought leadership. 7 00:00:16,685 --> 00:00:19,605 From powerful healthcare decision makers Support our show 8 00:00:19,705 --> 00:00:22,525 by leaving it a five star rating and review on Apple Podcast 9 00:00:22,745 --> 00:00:24,005 or other platforms you use. 10 00:00:24,155 --> 00:00:26,005 It's a chance to tell us what you like about the show 11 00:00:26,025 --> 00:00:27,245 and act on your feedback. 12 00:00:27,265 --> 00:00:29,205 Thanks for listening. Now here's the episode. 13 00:00:30,395 --> 00:00:32,645 - This is Chris Sosa with the Becker's Healthcare Podcast. 14 00:00:33,385 --> 00:00:35,605 I'm thrilled today to be joined by Amanda Vest, md, 15 00:00:35,715 --> 00:00:36,725 medical Director 16 00:00:36,725 --> 00:00:39,765 of the Cardiac Transplant Program at Tufts Medical Center. 17 00:00:40,305 --> 00:00:41,885 Dr. Vest, thank you for joining us today. 18 00:00:42,655 --> 00:00:43,805 - Thank you for having me, Chris. 19 00:00:45,465 --> 00:00:47,245 - Dr. Vest, could you please introduce yourself 20 00:00:47,245 --> 00:00:48,565 and tell us a bit about your background? 21 00:00:49,395 --> 00:00:51,805 - Yeah, certainly. I'm a heart failure 22 00:00:51,825 --> 00:00:53,085 and transplant cardiologist, 23 00:00:53,145 --> 00:00:55,925 and I lead the Advanced Heart Failure Program here at Tufts 24 00:00:55,925 --> 00:00:57,085 Medical Center in Boston. 25 00:00:57,905 --> 00:01:01,405 I'm originally from the uk and I trained in London, Boston 26 00:01:01,585 --> 00:01:02,605 and Cleveland, Ohio. 27 00:01:03,275 --> 00:01:06,045 Currently I mostly see patients with heart failure, 28 00:01:06,705 --> 00:01:09,005 cardiomyopathies transplantation, 29 00:01:09,065 --> 00:01:10,725 and mechanical circulatory support. 30 00:01:11,355 --> 00:01:14,485 Another area of interest for me is the treatment of obesity. 31 00:01:15,285 --> 00:01:18,125 I medically treat obesity in patients with heart failure 32 00:01:18,385 --> 00:01:21,285 and also co-direct the clinical nutrition course here at 33 00:01:21,405 --> 00:01:22,965 Tufts University School of Medicine. 34 00:01:23,545 --> 00:01:26,645 And actually my research area is in nutrition, metabolism 35 00:01:27,025 --> 00:01:28,045 and body composition 36 00:01:28,545 --> 00:01:30,885 and for example, learning how to help patients 37 00:01:30,885 --> 00:01:32,565 with skeletal muscle wasting 38 00:01:32,625 --> 00:01:34,405 who have heart failure as a condition. 39 00:01:35,305 --> 00:01:37,925 But super excited to join you today to talk on some 40 00:01:37,925 --> 00:01:38,925 of these transplant topics. 41 00:01:40,195 --> 00:01:41,805 - Wonderful, thank you Dr. Va. 42 00:01:41,905 --> 00:01:44,165 So looking at the, the bigger picture here, so 43 00:01:44,165 --> 00:01:45,685 what would you say are the three biggest 44 00:01:45,685 --> 00:01:46,925 issues in cardiology? 45 00:01:47,285 --> 00:01:49,325 I know that's a lot, so, so take that as you will. 46 00:01:50,185 --> 00:01:51,365 - Yes, absolutely. 47 00:01:51,365 --> 00:01:53,845 Well, I come at it with a bit of a transplant lean, 48 00:01:54,185 --> 00:01:56,045 but I'll start on the prevention end. 49 00:01:56,105 --> 00:01:58,445 And because I am interested in nutrition 50 00:01:58,445 --> 00:02:01,845 and obesity, I think it's such an exciting time in terms 51 00:02:01,905 --> 00:02:03,365 of understanding 52 00:02:03,585 --> 00:02:06,445 how we prevent people from developing cardiovascular 53 00:02:06,565 --> 00:02:10,045 diseases, specifically including, uh, heart failure 54 00:02:10,045 --> 00:02:14,445 because obesity is a major risk factor for it with our, um, 55 00:02:14,775 --> 00:02:17,805 newer medications that treat metabolic health. 56 00:02:17,865 --> 00:02:19,645 So particularly the GLP one agonist. 57 00:02:19,655 --> 00:02:21,525 We've had some really interesting data lately 58 00:02:21,525 --> 00:02:24,445 with a select study at American Heart Association, 59 00:02:24,625 --> 00:02:26,485 and I think there are huge opportunities there 60 00:02:26,785 --> 00:02:30,165 to help our populations of patients with diabetes 61 00:02:30,225 --> 00:02:33,525 and obesity from developing cardiovascular disease at all. 62 00:02:34,305 --> 00:02:36,125 In terms of the heart failure realm, 63 00:02:36,405 --> 00:02:39,245 I think there's a lot more that we still have to do 64 00:02:39,745 --> 00:02:41,405 for timely diagnosis 65 00:02:41,825 --> 00:02:44,245 and implementation of our medical therapies 66 00:02:44,705 --> 00:02:46,005 for people with heart failure. 67 00:02:46,665 --> 00:02:50,005 We have about 6.7 million American adults living 68 00:02:50,005 --> 00:02:51,365 with heart failure at this time. 69 00:02:52,025 --> 00:02:54,885 Um, and not all of them are picked up in a timely manner, 70 00:02:55,145 --> 00:02:57,765 and unfortunately not all of them are treated 71 00:02:57,765 --> 00:03:00,325 with the therapies that we know can be lifesaving 72 00:03:00,545 --> 00:03:02,285 and that can help recover their heart. 73 00:03:02,465 --> 00:03:04,485 So, uh, there's a lot more there 74 00:03:04,545 --> 00:03:08,605 to be done in collaboration across primary care, cardiology, 75 00:03:09,225 --> 00:03:12,445 um, and, uh, uh, medical, uh, specialties. 76 00:03:12,985 --> 00:03:15,005 But lastly, getting to the transplant area, 77 00:03:15,235 --> 00:03:18,125 it's such an exciting time to be in heart transplantation 78 00:03:18,475 --> 00:03:22,605 because we've really been able to optimize, uh, access 79 00:03:22,605 --> 00:03:26,165 to heart transplantation, build up the volumes 80 00:03:26,305 --> 00:03:29,365 of transplantation in the United States over the last few 81 00:03:29,365 --> 00:03:32,565 years, and really start to look at the way 82 00:03:32,565 --> 00:03:34,525 that we manage patients longer term 83 00:03:34,695 --> 00:03:37,125 after a heart transplant, for example, 84 00:03:37,335 --> 00:03:41,485 innovating in the ways that we surveil for rejection, um, 85 00:03:41,665 --> 00:03:43,845 and bringing it back again to metabolic health. 86 00:03:43,845 --> 00:03:46,685 Thinking about how do we keep these patients surviving 87 00:03:46,945 --> 00:03:50,165 and thriving for the long-term after a heart transplant. 88 00:03:51,965 --> 00:03:54,585 - Dr. Wess, I'm glad you mentioned the collaboration aspect. 89 00:03:54,935 --> 00:03:57,225 What do you see as the biggest challenges as far as 90 00:03:57,225 --> 00:03:59,465 that element is concerned and how can they be overcome? 91 00:04:00,475 --> 00:04:02,465 - Right. I think we're really in a phase now of trying 92 00:04:02,465 --> 00:04:06,865 to break down the silos between, um, primary care 93 00:04:07,045 --> 00:04:09,105 and those who specialize in cardiology. 94 00:04:09,525 --> 00:04:13,905 In endocrinology and nephrology, we're hearing a lot about, 95 00:04:14,445 --> 00:04:18,425 um, metabolic kidney, cardiovascular health, 96 00:04:18,845 --> 00:04:22,785 and it really takes people working across those domains, 97 00:04:23,025 --> 00:04:24,625 collaborating together, um, 98 00:04:24,885 --> 00:04:28,865 and, um, using often common medications to 99 00:04:29,375 --> 00:04:32,025 gain in multiple areas of a patient's health. 100 00:04:32,285 --> 00:04:37,025 So we saw this a lot as the SGLT two inhibitors became, um, 101 00:04:37,085 --> 00:04:40,145 proven and approved for patients with heart failure 102 00:04:40,145 --> 00:04:41,625 with reduced ejection fraction 103 00:04:41,885 --> 00:04:43,825 and also preserved ejection fraction 104 00:04:44,015 --> 00:04:46,185 that no longer was this group of medications, 105 00:04:46,215 --> 00:04:48,025 just the domain of the endocrinologist. 106 00:04:48,525 --> 00:04:51,265 But now it was very much the domain of the cardiologist 107 00:04:51,285 --> 00:04:53,585 and the primary care provider treating patients 108 00:04:53,585 --> 00:04:55,545 with heart failure and furthermore, 109 00:04:55,645 --> 00:04:57,745 has benefits in chronic kidney disease as well. 110 00:04:58,245 --> 00:05:01,705 Um, similarly, we are seeing now in the GLP one 111 00:05:01,725 --> 00:05:04,465 and GIP GLP one agonist medications, 112 00:05:04,765 --> 00:05:08,225 the opportunity not only to treat the type two diabetes, 113 00:05:08,845 --> 00:05:12,945 but also to treat obesity and of course optimize metabolic 114 00:05:12,965 --> 00:05:14,065 and cardiovascular health. 115 00:05:14,125 --> 00:05:17,385 So it really brings all those subspecialty, uh, 116 00:05:17,405 --> 00:05:20,225 and general medicine groups together to center 117 00:05:20,225 --> 00:05:22,985 around the patient and figure out what's gonna be right 118 00:05:22,985 --> 00:05:25,345 for them for their long-term cardiovascular wellbeing. 119 00:05:27,505 --> 00:05:30,475 - Another sort of big picture question here for you, Dr. 120 00:05:30,475 --> 00:05:33,155 Vest. So when you see the evolution of heart, heart care, 121 00:05:33,355 --> 00:05:35,315 I should say mm-hmm, the next 18 months 122 00:05:35,315 --> 00:05:38,115 or so, two, three years, what do you think is going 123 00:05:38,115 --> 00:05:40,755 to be the biggest trend that is coming the way of 124 00:05:40,755 --> 00:05:42,195 that specialty? 125 00:05:43,415 --> 00:05:45,675 - Oh, so many exciting developments 126 00:05:45,675 --> 00:05:47,555 with medications and devices. 127 00:05:48,535 --> 00:05:52,035 Um, but perhaps I'll focus on my area of transplant. 128 00:05:52,185 --> 00:05:56,995 It's really been, uh, a fantastic few years of innovation 129 00:05:57,665 --> 00:06:00,165 in the way that heart transplantation is done 130 00:06:00,185 --> 00:06:02,645 and how we care for the patients afterwards. 131 00:06:03,225 --> 00:06:06,165 And an area that's been particularly interesting 132 00:06:06,785 --> 00:06:10,125 is the clinical trial and subsequent adoption 133 00:06:10,125 --> 00:06:12,045 and clinical practice of donation 134 00:06:12,045 --> 00:06:16,805 after circulatory death, DCD, which is a type of heart donor 135 00:06:16,995 --> 00:06:21,005 that wasn't previously standard, um, in the United States, 136 00:06:21,465 --> 00:06:26,245 but which has helped us to transplant more patients, um, 137 00:06:26,585 --> 00:06:28,125 and get very good outcomes 138 00:06:28,745 --> 00:06:33,085 and was facilitated by the development of new technology for 139 00:06:33,625 --> 00:06:37,765 the, um, optimization of a donor heart graft 140 00:06:38,145 --> 00:06:40,925 and the transport of it to the recipient hospital. 141 00:06:41,745 --> 00:06:44,565 And there are a number of other innovations ongoing at the 142 00:06:44,565 --> 00:06:47,565 moment with slightly different devices that seek 143 00:06:47,625 --> 00:06:51,925 to really revolutionize the way that we, um, uh, 144 00:06:52,265 --> 00:06:54,805 manage that heart and transport it in 145 00:06:55,015 --> 00:06:58,085 after procurement to get it in the best states 146 00:06:58,345 --> 00:06:59,645 for a transplant surgery. 147 00:06:59,865 --> 00:07:03,045 So I think this is a very exciting area as we think about 148 00:07:03,425 --> 00:07:05,645 how can we make sure that we get access to 149 00:07:05,645 --> 00:07:07,845 as many heart transplants of excellent quality 150 00:07:08,225 --> 00:07:10,205 for our patients on the wait list, knowing 151 00:07:10,205 --> 00:07:14,085 that unfortunately we still have approximately 9% 152 00:07:14,085 --> 00:07:16,045 of patients who are listed for transplant 153 00:07:16,645 --> 00:07:19,085 ultimately passing away without receiving a heart. 154 00:07:19,465 --> 00:07:22,165 And so the race is really on to figure out 155 00:07:22,265 --> 00:07:24,765 how we can bring heart transplant to those who need it. 156 00:07:26,185 --> 00:07:28,245 - Uh, Dr. VAs, could you elaborate a little bit on some 157 00:07:28,245 --> 00:07:30,365 of the technology that you find most exciting? 158 00:07:31,585 --> 00:07:32,645 - Yes, absolutely. 159 00:07:33,185 --> 00:07:35,885 Um, so the donation 160 00:07:35,885 --> 00:07:39,245 after circulatory death, um, option really came about 161 00:07:39,315 --> 00:07:41,245 because of a type 162 00:07:41,245 --> 00:07:43,245 of equipment we call the organ care system. 163 00:07:43,825 --> 00:07:46,445 Um, the uh, system 164 00:07:46,445 --> 00:07:49,485 that was developed in a clinical trial over the last couple 165 00:07:49,485 --> 00:07:51,925 of years is made by a company called Edix 166 00:07:52,465 --> 00:07:55,765 and allows us to take a heart, um, even one 167 00:07:55,765 --> 00:07:57,805 that has stopped beating, which is the case 168 00:07:57,805 --> 00:08:00,725 with DCD transplantation, which we thought used 169 00:08:00,725 --> 00:08:04,245 to render the heart inappropriate for transporting 170 00:08:04,425 --> 00:08:08,645 and uh, transplantation given that it had stopped beating. 171 00:08:09,105 --> 00:08:10,525 But we now know we can place 172 00:08:10,525 --> 00:08:12,765 that heart onto the organ care system 173 00:08:13,505 --> 00:08:18,005 and perfuse it with blood and electrolytes, warm it 174 00:08:18,385 --> 00:08:20,685 and get it beating again in such a way 175 00:08:20,685 --> 00:08:23,765 that we're not only able to improve the quality of 176 00:08:23,765 --> 00:08:27,685 that organ, but also assess it whilst it's on the platform. 177 00:08:28,425 --> 00:08:31,525 So this has opened up, uh, the option of, uh, 178 00:08:31,725 --> 00:08:33,085 DCD transplantation, 179 00:08:33,085 --> 00:08:36,045 which probably adds somewhere in the realm of another, 180 00:08:36,055 --> 00:08:37,885 about 15% volume 181 00:08:38,145 --> 00:08:40,165 of good quality donor hearts being 182 00:08:40,165 --> 00:08:41,445 available to our patients. 183 00:08:41,905 --> 00:08:45,725 And furthermore, starts to give us more flexibility about 184 00:08:45,745 --> 00:08:48,605 how we can transport hearts over longer 185 00:08:48,605 --> 00:08:50,085 geographic distances. 186 00:08:50,545 --> 00:08:54,965 No longer are we beholden to the cold static storage of a, 187 00:08:54,965 --> 00:08:57,325 a lowly cooler, which used to be the way 188 00:08:57,325 --> 00:08:59,165 that we brought hearts to the recipient, 189 00:08:59,745 --> 00:09:03,685 but now we have platforms where we can keep that heart, uh, 190 00:09:03,745 --> 00:09:07,285 in good shape over a longer period as we bring the heart, 191 00:09:07,385 --> 00:09:08,885 for example, from coast to coast. 192 00:09:08,885 --> 00:09:12,085 In the US there are a number of other technologies 193 00:09:12,355 --> 00:09:13,765 that are being developed. 194 00:09:14,265 --> 00:09:18,045 Uh, we can do DCD transplantation using something called 195 00:09:18,045 --> 00:09:21,925 Norm Themic Regional Perfusion, uh, which utilizes some 196 00:09:21,925 --> 00:09:24,685 of our ECMO technology in circulating 197 00:09:24,735 --> 00:09:26,005 blood outside the body. 198 00:09:26,665 --> 00:09:30,725 We have other options for cold static storage, for example, 199 00:09:31,765 --> 00:09:35,605 building on the idea of a heart on ice in the cooler, 200 00:09:36,225 --> 00:09:39,445 but regulating the temperature throughout the organ in a 201 00:09:39,445 --> 00:09:41,805 much more uniform way that's achieved 202 00:09:41,945 --> 00:09:45,005 by a device called the Sherpa Pack from Paragons, 203 00:09:45,185 --> 00:09:47,805 and allows us to monitor the temperature, um, 204 00:09:48,025 --> 00:09:51,565 during a period of transport of the organ, uh, 205 00:09:51,595 --> 00:09:55,325 with some early data from our team at Tufts, uh, suggesting 206 00:09:55,325 --> 00:09:57,925 that that heart can be transported a little further 207 00:09:58,105 --> 00:10:00,045 and longer and still be of good quality. 208 00:10:01,355 --> 00:10:04,085 Another device that's coming into trials is something called 209 00:10:04,085 --> 00:10:05,845 the Ex Vivo, um, device 210 00:10:05,845 --> 00:10:08,085 where the heart is continuously perfused 211 00:10:08,185 --> 00:10:11,605 and a, a cold eight degree Celsius oxygenated 212 00:10:12,165 --> 00:10:14,645 cardioplegic nutrition hormone solution. 213 00:10:15,065 --> 00:10:19,365 So not yet available, um, or FDA approved in the us 214 00:10:19,585 --> 00:10:20,885 but coming into trials 215 00:10:20,955 --> 00:10:23,085 with some exciting data internationally, 216 00:10:24,735 --> 00:10:25,825 - 15% Dr. 217 00:10:25,825 --> 00:10:29,185 Vest, that seems like no small number when it comes 218 00:10:29,205 --> 00:10:32,225 to the number of hearts that are available for transplant. 219 00:10:34,425 --> 00:10:36,945 - Absolutely. Um, expanding access 220 00:10:37,045 --> 00:10:39,425 to heart transplantation is so important. 221 00:10:40,125 --> 00:10:42,545 Um, and looking to, uh, 222 00:10:42,775 --> 00:10:46,705 utilize all available hearts is absolutely key to that. 223 00:10:47,465 --> 00:10:51,145 A lot of work has gone into the concept of how do we 224 00:10:52,065 --> 00:10:55,385 optimize hearts, um, ensure that any, um, 225 00:10:55,785 --> 00:10:58,505 possible donor is being considered for donation, 226 00:10:58,925 --> 00:11:02,345 but certainly using DCD hearts, being able 227 00:11:02,345 --> 00:11:04,305 to be geographically more flexible 228 00:11:04,305 --> 00:11:07,945 with these organ preservation and transport systems, um, 229 00:11:08,205 --> 00:11:11,145 and also using hearts, for example, from donors 230 00:11:11,205 --> 00:11:13,545 who have Hepatitis C, which has become standard 231 00:11:13,565 --> 00:11:16,665 of care over the last decade, are all strategies 232 00:11:16,665 --> 00:11:20,385 that incrementally add up to bring more heart transplants 233 00:11:20,385 --> 00:11:21,785 to the patients who need them. 234 00:11:22,365 --> 00:11:26,425 And amazingly, we're now at more than 4,000 heart 235 00:11:26,425 --> 00:11:28,585 transplants a year in the United States. 236 00:11:29,165 --> 00:11:32,425 Um, so really, uh, increasing on that volume 237 00:11:32,805 --> 00:11:34,425 and simultaneously, of course, 238 00:11:34,855 --> 00:11:38,625 many people doing excellent work on enhancing the equity 239 00:11:39,125 --> 00:11:43,305 and access amongst populations to this lifesaving resource. 240 00:11:45,555 --> 00:11:47,255 - Dr. West a little bit on the flip side 241 00:11:47,255 --> 00:11:49,055 of this conversation that we've been having 242 00:11:49,075 --> 00:11:50,255 for the last few minutes, uh, 243 00:11:50,255 --> 00:11:52,655 what would you say makes you a little bit nervous and 244 00:11:52,655 --> 00:11:55,525 or what would you like to see improved as far as 245 00:11:56,195 --> 00:11:57,525 your specialty is concerned? 246 00:11:58,745 --> 00:12:01,565 - Yes. Well, with all these wonderful technologies 247 00:12:01,755 --> 00:12:04,925 that has come, of course, the potential for increasing cost, 248 00:12:05,705 --> 00:12:08,845 um, so that has certainly been something that, uh, 249 00:12:09,035 --> 00:12:12,445 many programs have had to look carefully at. 250 00:12:12,585 --> 00:12:15,565 And I think we'll see a lot more over the next few years 251 00:12:15,655 --> 00:12:17,725 about thinking about cost effectiveness 252 00:12:18,185 --> 00:12:21,965 and how we can, um, geographically share hearts 253 00:12:21,965 --> 00:12:23,365 and get them where we need them to be, 254 00:12:23,425 --> 00:12:25,365 but be smart in our resources. 255 00:12:25,585 --> 00:12:29,525 And already a lot of work is going on to, um, really think 256 00:12:29,725 --> 00:12:34,205 through the systems of care whereby teams are, um, 257 00:12:34,555 --> 00:12:37,565 located in hubs and sent out to recover hearts 258 00:12:37,785 --> 00:12:39,845 and bring them back to the center that needs them. 259 00:12:39,985 --> 00:12:41,405 So a lot of good work there. 260 00:12:42,095 --> 00:12:44,285 We've also got really exciting technologies 261 00:12:44,585 --> 00:12:47,285 for monitoring patients after heart transplantation. 262 00:12:47,865 --> 00:12:49,725 So for example, the surveillance 263 00:12:49,745 --> 00:12:53,165 for rejection has traditionally been, um, the biopsy, 264 00:12:53,575 --> 00:12:55,605 which goes into the right side of the heart 265 00:12:55,665 --> 00:12:57,445 and takes a sample of myocardium 266 00:12:57,445 --> 00:12:59,085 to be examined under the microscope. 267 00:12:59,785 --> 00:13:02,365 But we've got real opportunities now to do a lot more 268 00:13:02,365 --> 00:13:04,445 of the surveillance less invasively using 269 00:13:04,975 --> 00:13:06,845 donor derived cell-free DNA, 270 00:13:07,415 --> 00:13:10,245 which is a blood test currently commercially available 271 00:13:10,825 --> 00:13:12,645 on next generation sequencing 272 00:13:12,835 --> 00:13:16,165 that quantifies the donor derived cell-free DNA, 273 00:13:16,705 --> 00:13:19,965 and can use single nucleotide variations 274 00:13:20,545 --> 00:13:22,605 to give a ratio of that 275 00:13:23,295 --> 00:13:27,605 donor derived cell-free DNA coming from the heart versus the 276 00:13:27,605 --> 00:13:30,845 total pool of DNA that comes from the recipient's body. 277 00:13:31,505 --> 00:13:34,765 Um, when the heart is under stress, such as during a episode 278 00:13:34,765 --> 00:13:37,245 of rejection, the donor derived fraction 279 00:13:37,245 --> 00:13:38,925 that's coming from the heart increases 280 00:13:39,145 --> 00:13:41,005 and that can help us understand 281 00:13:41,005 --> 00:13:43,205 that the heart is having some difficulty 282 00:13:43,225 --> 00:13:44,845 and needs further investigation. 283 00:13:45,385 --> 00:13:48,245 Or on the flip side, that the heart is actually doing well, 284 00:13:48,665 --> 00:13:52,285 um, has a low donor drive cell-free DNA level, um, 285 00:13:52,305 --> 00:13:54,805 and that the patient can continue their medications 286 00:13:54,985 --> 00:13:56,765 and continue in the direction they're going. 287 00:13:57,305 --> 00:13:58,605 But you asked about the challenges 288 00:13:58,665 --> 00:14:02,885 and it can be quite difficult to, um, roll out some 289 00:14:02,925 --> 00:14:05,485 of these changes in care across programs. 290 00:14:05,665 --> 00:14:06,685 Caring for patients 291 00:14:06,685 --> 00:14:08,925 with heart transplants is incredibly complex. 292 00:14:09,465 --> 00:14:12,805 Um, it's a high risk situation where we need a high burden 293 00:14:12,865 --> 00:14:15,605 of proof that changes in our protocols 294 00:14:15,665 --> 00:14:16,765 are safer and effective. 295 00:14:17,105 --> 00:14:19,565 And so we have seen some differences in the speed 296 00:14:19,635 --> 00:14:22,485 with which these new technologies are adopted 297 00:14:22,505 --> 00:14:23,845 across different programs. 298 00:14:24,265 --> 00:14:25,685 Um, and I think coming together 299 00:14:25,785 --> 00:14:28,725 as a community providing educational resources 300 00:14:29,025 --> 00:14:30,925 and disseminating the data that's coming 301 00:14:30,925 --> 00:14:33,365 through from research studies can be very helpful 302 00:14:33,945 --> 00:14:36,205 in getting pat in getting programs to the point 303 00:14:36,205 --> 00:14:39,045 where they're comfortable, uh, taking on some 304 00:14:39,045 --> 00:14:41,485 of these newer innovations for patients 305 00:14:41,485 --> 00:14:42,565 with heart transplantation. 306 00:14:44,545 --> 00:14:48,005 - Doctor, I did wanna ask you a little bit about a that, uh, 307 00:14:48,005 --> 00:14:51,445 your health system had early this year where you had a 308 00:14:52,135 --> 00:14:54,925 transplant candidate who received a heart 309 00:14:54,925 --> 00:14:57,525 after seven months in the care of the hospital. 310 00:14:57,745 --> 00:15:00,805 So can you take me through just a little bit about how 311 00:15:00,805 --> 00:15:01,925 that process went 312 00:15:02,065 --> 00:15:03,845 and what was it like, what it was like 313 00:15:03,845 --> 00:15:06,725 to finally tell this person, Hey, we have a heart form? 314 00:15:08,425 --> 00:15:09,805 - Yes, absolutely. 315 00:15:09,945 --> 00:15:13,325 Our, um, patients do sometimes wait a very long time 316 00:15:13,345 --> 00:15:16,005 for heart transplantation, which can be an incredibly 317 00:15:16,805 --> 00:15:18,485 challenging journey for them and their family. 318 00:15:19,385 --> 00:15:23,485 Um, these days, many of our heart transplants occur 319 00:15:23,585 --> 00:15:26,125 for patients who are supported on temporary mechanical 320 00:15:26,125 --> 00:15:31,085 circulatory support, so heart pumps that are, um, 321 00:15:31,335 --> 00:15:33,325 optimizing the blood flow around the body 322 00:15:33,465 --> 00:15:34,765 and for which the patient needs 323 00:15:34,765 --> 00:15:36,565 to stay in the intensive care unit. 324 00:15:37,585 --> 00:15:41,005 We, um, try to get the patient as active 325 00:15:41,305 --> 00:15:44,325 and up moving around as much as possible during this period, 326 00:15:44,425 --> 00:15:47,405 but still it's very challenging to be confined 327 00:15:47,405 --> 00:15:51,005 to an intensive care unit for a long period of time, um, 328 00:15:51,015 --> 00:15:53,565 often with lots of medical and emotional ups 329 00:15:53,565 --> 00:15:54,565 and downs along the way. 330 00:15:54,705 --> 00:15:57,845 So it's one of the greatest privileges of my job to be able 331 00:15:57,945 --> 00:16:01,685 to talk to a patient about receiving a match, um, 332 00:16:01,945 --> 00:16:06,285 and help them to get through to realizing all those future 333 00:16:06,895 --> 00:16:09,245 goals and, um, achievements 334 00:16:09,245 --> 00:16:10,845 that they're looking for in their life. 335 00:16:11,355 --> 00:16:12,365 Just the nicest thing. 336 00:16:12,505 --> 00:16:16,805 So, um, certainly, uh, a, a challenging process 337 00:16:17,265 --> 00:16:18,525 for many of our patients, 338 00:16:18,825 --> 00:16:20,885 but really delightful when we're able 339 00:16:20,885 --> 00:16:22,605 to give people a new lease on life. 340 00:16:23,105 --> 00:16:24,525 And really wonderful 341 00:16:24,525 --> 00:16:26,925 that this year we've had a very busy year 342 00:16:26,925 --> 00:16:27,965 at Tufts Medical Center. 343 00:16:28,095 --> 00:16:29,765 We're not quite through 2023, 344 00:16:29,825 --> 00:16:32,405 but we've done 56 heart transplants this year, 345 00:16:32,855 --> 00:16:36,525 which actually equals our record in the New England region 346 00:16:36,755 --> 00:16:39,405 that we set back in 2016 for the most number 347 00:16:39,405 --> 00:16:42,245 of heart transplants in this region in a year. 348 00:16:42,465 --> 00:16:45,125 So hopefully we'll be able to keep moving forwards 349 00:16:45,125 --> 00:16:46,805 and offer this gift of life 350 00:16:46,805 --> 00:16:49,405 to even more patients on our waiting list 351 00:16:49,505 --> 00:16:50,605 as we wrap up the year. 352 00:16:51,585 --> 00:16:53,725 - Dr. West, thank you so much for being so generous 353 00:16:53,725 --> 00:16:55,085 with your time and insights today. 354 00:16:55,105 --> 00:16:56,765 We can't wait to share them with our audience. 355 00:16:56,765 --> 00:16:58,325 Julie, uh, thank you again, 356 00:16:58,385 --> 00:17:00,765 and we look forward to connecting with you soon. 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