Advances in Hemodynamic Support and Transplant Care

The treatment for end-stage heart failure continues to rapidly evolve. In the area of mechanical circulatory support, next-generation artificial hearts are evolving away from conventional total artificial hearts and are moving toward smaller-sized axial/mixed-flow pumps with physiological hemodynamics. The need to quantitatively understand the relationship between the shear stress distribution produced by impeller design and the activation of platelets/von Willebrand factor cleavage is urgent. In the area of transplantation, the fine-tuning of immunosuppressive regimens will entail a need for more precise biomarkers. In addition, techniques to preserve donor hearts and ex vivo perfusion systems are providing a capacity to redefine standards for assessing organ viability. Another vital research area requiring interdisciplinary collaboration is the sensitization response resulting from mechanical support as a bridge to transplantation and their subsequent role in organ rejection post-transplant. All of these important advances require further understanding of device-blood-immune systems interactions.

The objective of this Research Topic is to create an interdisciplinary venue centered around these key questions: 1) How can we improve hemocompatibility and hemodynamic performance of artificial hearts with multi-physics optimization; 2) How can we increase long term survival after heart transplant with novel immune monitoring and intervention methods and 3) How can we understand and modulate the relationship between mechanical support and transplant immunology. We anticipate soliciting contemporary research from hemodynamics, biomaterials, immunology, and transplant research for the collective advancement of comprehensive interventions for individuals with end-stage heart failure.

We invite research and review articles that tackle the subjects listed below:

● Hemodynamic optimization and hemocompatibility of artificial hearts: control of shear stress in impeller design, simulations of physiological pulsatile flow, prediction models of blood trauma

● Immune tolerance and monitoring of rejection in heart transplant: mechanisms of production of donor specific antibody (DSA), monitoring value of cell free DNA (cfDNA), clinical applications of regulatory T cells (Treg)

● Donor heart preservation and evaluation: metabolic assessment in ex vivo perfusion systems, monitoring of mitochondrial function, roles of inflammatory signaling pathways in ischemia-reperfusion injury

● Cross-interactions between mechanical support and transplant: mechanisms of sensitization by VAD, immunomodulatory effects of implanted devices, management of post-transplant infection risk

● Exploration of new therapeutics: immunomodulatory biomaterials, use of gene editing technologies in transplant immunology, hybrid therapies combining xenotransplantation with mechanical support.