This supplement presents a set of 18 original, CME-accredited talks and three panel discussions presented at the 7th Annual Acute Cardiac Unloading and REcovery (A-CURE) Symposium, held on 4 November 2022 in Chicago (IL, US). The symposium proceeded with four rich sessions, as detailed below.
Session I covered ‘Advances in Basic and Preclinical Science of Acute Unloading and Myocardial Recovery’. This session featured four presentations with state-of-the-art preclinical work in cardiac unloading. Dr Bart Meyns opened the session with fascinating data on reverse remodelling in an ovine model of chronic heart failure (HF). Two talks on the topic ECPella followed, with Dr Steven Keller presenting his group’s careful haemodynamic work comparing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) combination with Impella versus intra-aortic balloon pump therapy and Dr Ann Banke presenting data on the impact of left ventricular unloading in cardiac energetics. Dr Spyros Marvropoulos then shared data on extracellular matrix modifications during cardiac unloading. The session closed with the keynote lecture delivered by Dr Biykem Bozkurt on ‘Decompensated Heart Failure, Taking the Acute out of Decompensation’. Dr Bozkurt educated the audience on the need to reconceptualise HF and proposed new ways to classify HF and optimise patient care.
Session II consisted of five talks that examined the ‘Clinical Science and Evidence for Cardiac Unloading and Recovery’. Dr William O’Neill opened the session with an intriguing talk covering the roll-in experience of the STEMI-DTU pivotal trial, asking the question whether unloading the left ventricle is the key to improving survival in anterior wall acute MI. Dr Navin Kapur followed, with data from the STEMI-DTU pilot study that provided clinical evidence that delaying reperfusion by 30 min under active left ventricular unloading may reduce ischaemic symptoms and infarct size in anterior ST-elevation MI (STEMI). Following the two talks on the STEMI-DTU trial, Dr Ralf Westenfield presented pilot phase data from the PROTECT Kidney randomised controlled trial, revealing a positive signal towards improved renal outcomes in the Impella arm.
The last two talks of the session covered the topic of device algorithms and data-driven metrics that can help optimise patient care. Dr Benedikt Schrage presented clinical data from the newly developed VA-ECMO mode, an Impella system algorithm that aids in simultaneous management of Impella and VA-ECMO. Dr Christian Moyer wrapped up the session with a talk on the development of the SmartPump system, which allows diagnostic measurement of various cardiac metrics with the Impella system, closing with a vision of the comprehensive management of critical care patients using smart digital tools.
Session III featured three renowned cardiac specialists presenting the ‘Upcoming Trials in the Clinical Applications of Cardiac Unloading’. Dr Benedikt Schrage presented the UNLOAD-ECMO randomised controlled trial for left ventricular unloading with VA-ECMO in severe cardiogenic shock; Dr Mir Babar Basir presented the CERAMICS study to evaluate best practices for mechanical circulatory support escalation and management in acute MI–cardiogenic shock; and Dr Alex Nap presented the UNLOAD-HF randomised controlled trial for left ventricular unloading in acute HF.
Session IV included three presentations and two panel discussions on the Frontiers in Surgical and Clinical Applications of Unloading. Dr Luca Baldetti opened with a talk highlighting the importance of correct positioning of Impella implantation to avoid device-related complications and to optimise its function using a novel fluoroscopic approach. Dr Kay Everett presented clinical data suggesting that maximal left ventricular unloading improves biventricular performance in patients with acute decompensated HF and cardiogenic shock. Dr Ryan Tedford followed on the topic of biventricular HF with his presentation, demonstrating that right ventricular reserve may be a useful measure of right ventricular function to predict right ventricular failure after left ventricular assist device implantation.
In addition to the live talks, scientific posters were accepted for A-CURE 2022 from top-class researchers around the world. The posters can be viewed at the A-CURE website (https://a-cure.org/livestream/). Of the submitted abstracts, the A-CURE faculty selected two award winners: The Young Investigator Award went to Dr Lija Swain of Tufts Medical Center for her presentation ‘Trans-valvular Unloading Reduces Anaerobic Glycolysis Before Reperfusion and Preserves Energy Substrate Utilisation after Reperfusion in Models of Acute Myocardial Infarction’. The Best in Research Award went to Dr Tomoki Sakata of Icahn School of Medicine at Mount Sinai for his research presentation ‘Mechanical LV Unloading Increases Coronary Flow by Prolonging Diastolic Phase’.
This supplement also contains summaries from the three faculty-led panel discussions. The first panel discussed Heart Recovery in the Real-world Setting with the global leaders in HF. The second panel addressed the topic of ‘Cutting-edge Surgical Applications of pVAD and Patient Management’ with a group of cardiac surgeons. The last panel discussion centred on ‘Non-cardiac Surgery Interventions on Patients Receiving Impella Support’, featuring the unique collaboration between cardiologists and general surgeons.
The presentations highlighted exciting new developments and represented substantial advances in the field of acute myocardial unloading and heart recovery over the past year. The A-CURE Working Group meeting is unique in including a diverse group of experts from various disciplines within an open, constructive and intimate public setting. We hope that you find this supplement informative and interesting. 