Listen in as speakers Dr. David Baran and Dr. JoAnn Lindenfeld give a post-lecture interview with Dr. Ugochukwu Egolum, Program Director of the Cardiovascular Disease Fellowship Program and Medical Director of the Heart Failure Treatment & Recovery Center at Georgia Heart Institute. Both Dr. Baran and Lindenfeld share their thoughts on what’s in store for both heart transplant and LVAD therapies for heart failure patients.
All right. Uh Good afternoon. Uh Pleasure to uh welcome you guys to our Georgia Heart Institute symposium today. Uh Today, I have the pleasure of uh discussing uh what happened with doing our heart failure session with Doctor Baron and uh Doctor Linden Feld. So how have you guys found our uh Georgia Heart Institute uh symposium so far, I go to a lot of symposia. I would say this is one of the best. I've seen the breadth and quality uh very impressed, especially by a court thoracic team and what you're doing here. Excellent. Any comments, Joanne. Yeah, I think it was great. A lot of practical information. A lot of what we're going to see in the future. A lot of team building and what it takes to, to do all of these things. Well, so I thought it was great. Excellent. Now, the topic, we had you guys uh debate and it was quite a, quite a lovely and enlightening debate was really this idea of LVAD versus transplant and, and you know, is one better than the other. It was one first second. What, what are your thoughts on where the field is going with regard to either of these uh therapies, what's in the future for us. So I think, you know, in terms of ventricular cys device therapy, I think ultimately, in the long term devices will get smaller, the drive line eventually will go away, blood thinners will move away from warfarin to do ax. So still there will always be more titanium than there are the precious gift of human heart. And you have to decide which patients are appropriate for each one. I agree with that. I think that everything else being equal. If you could have a transplant tomorrow or an ed, you have, most people would choose a transplant for a number of reasons but not everybody can do that. So while I think transplants right now are a better option, if you can get one, this is a real individual decision that we need to consider a lot of things. How long will the wait be a number of other things about it to say, which is the best for each individual person and Linda fellow, you look down a pipeline of transplant. I mean, there's been a lot of innovations that's really improved the field. What are the other things that's in the pipeline and things that you think are likely to change in the next 5, 10 years. So I think that the two things that I would say that limit transplant the most are coral vasculopathy and the incidence of malignancy particularly in older patients as time goes on, those are probably the two most common causes of death. And so I think that one thing that we may see is our ability to limit immunosuppression. If we have mechanisms to decide how much is enough for any individual person. And also surveillance, we might be able to limit the excess of malignancy deaths. Corne vasculopathy is a harder nut to crack because it starts probably as an immunologic phenomenon that is rejection against the endothelium and probably starts almost initially. Although I believe that we will have some really interesting new data in about six months to suggest that we are going to be able to predict very likely who's going to get it. And I think there will be some ways potentially to prevent it. What I can say now is that just based on older data and our own data from Vanderbilt, we know that the quilty lesion we used to think didn't mean anything predicts coronary vasculopathy. And I think we know the reason why. So I think there are going to be some changes. It won't be immediate therapeutic changes. But I think just as LVAD is changing, I think transplant will change too. Excellent. I think those are very insightful points you make. Now as we wrap up, could you give me a few comments you would make for physicians in the community, a hospitalist, a primary care physician. What would you tell them about a run of the mill heart failure patient, what should they watch for and how should they try to get the patient the best care possible? Well, that's a great question. So I think the two things are one, we have four pillars of heart failure guideline, directed medical therapy now. And it's really imperative despite the costs for SGLT two antagonists and a that those be started as soon as possible. Secondly, I think it's really important to remember as we said before that heart failure is cardiac cancer and particularly if the patient presents to an emergency room or is admitted with heart failure, that should be a five alarm fire indication for referral. Certainly the second time, 100% and just watching and waiting and see how it goes is a mistake. Any comments, I agree completely. And I think there's a nice acronym called I need help which you can Google and it's all the things that would make you refer a heart for your patients. So repeated admissions, having to withdraw medications, not able to uptitrate guideline, directed medical therapy. Well, those are all I think indications for referral. So earlier referral I think is the key and that acronym will give you a really good idea of who to refer. Excellent. Well, there you have it. Uh uh you see about the excellent discussions we've had with our phenomenal world class faculty. Uh We thank you for tuning in and we'll see you next time
