Optimization of transient and permanent cardiopulmonary support in patients with heart and lung failure

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TP1 is the central project of the KFO311 for clinical and translationalresearch and organizes the prospective patient registry and thecollection of biomaterials. In the first funding period of the KFO311 wetransferred the existing clinical registries into a KFO311 registry, andestablished a server based data bank and biomaterial bank. Since2017 we included >250 patients with Impella pump and/orextracorporeal membrane oxygenation (ECMO) as well as >90patients carrying a left ventricular assist device (LVAD). Severalpublications originated from the registry, eg regarding left ventricularunloading by Impella pump, and surgical treatment of patients withpulmonary embolism supported by ECMO. We examine oral ironsupplementation in patients with pulmonary hypertension and rightheart failure (ORION-PH) and in patients after LVAD implantation(ORION-LVAD) in pilot studies. We included 80 patients with dilatedcardiomyopathy into the DETECT-ID registry and measured ironcontent in endomyocardial biopsies. In addition, we established anovel score for driveline infections in VAD patients. The goals of TP1in the next funding period are: 1.) Continuation of TP1 as centralclinical project. 2.) Extension of the data bank/biomaterial bankincluding consistent 30-day and 1-year follow-ups, collectionespecially of serial heart material (VAD/HTx). 3.) Development ofscores for the prediction of short-term and long-term outcomes ofpatients with (pre-)terminal heart and lung failure. 4.) Clinical (pilot)studies: Termination of the ORION-PH and ORION-LVAD studies onoral iron supplementation. Continuation together with TP2 of theDETECT-ID registry now with parallel biopsies of skeletal muscle forthe determination iron deficiency in the skeletal muscle compared tothe myocardium and to circulating iron parameters. Furthermore,using a pressure-volume-recording-catheter system we want tocharacterize in more depth patients with acute and preterminal heartfailure before and after implantation of support systems to enable animproved therapeutic management. With continuous measurementsof PA pressures in LVAD patients using the Cardio-Mems system weplan to optimize further LVAD settings. The prospective Germanmulticenter registry of RVAD implantations (ca. 50 patients/year) willbe included into the KFO311 registry. Patients who receive VA-ECMOduring resuscitation will be followed systematically to optimizetreatment strategies, and identify predictors of survival and neurological outcomes. In the randomized DanGer-Shock-Studyinvestigating Impella pump in patients with cardiogenic shock aftermyocardial infarction (primary endpoint mortality, supported byAbiomed), we will perform additional analyses of the efficiency ofmechanical unloading.