In 2014, the Organ Procurement and Transplant Network began reappraisal of the United States heart transplant allocation policy. Driven by ongoing discordance between organ supply and demand, high waitlist mortality, and increasing exception requests, the Thoracic Committee radically redesigned the priority scheme and drafted a 6-tiered algorithm, included durable device complications into policy, expanded broader sharing, and increased the number of mandatory listing variables to develop a future heart allocation score. This became the 2018 New Heart Allocation Policy. Changes in allocation priority have resulted in a significant increase in the use of temporary mechanical circulatory support in waitlisted candidates with a concomitant decrease in the number of patients bridged to transplanted with durable left ventricular assist device support. The number of exception requests continues to increase, particularly for patients listed status 2 and for multiorgan transplants. Importantly, fewer patients are being delisted for clinical improvement, suggesting missed opportunities for recovery. The current review will critically evaluate the 2018 heart allocation policy 6 years later, briefly focusing on the history of heart allocation in the United States, the current and evolving algorithms for candidate prioritization including continuous distribution, the impact of technology and innovation on transplant rates and future policy development, and the ongoing regulatory oversight and governance changes in the Organ Procurement and Transplant Network.

Despite randomized data for survival benefit (with class 1 recommendations) for treating heart failure (HF) with reduced ejection fraction using quadruple medical therapy (QMT)-defined as evidence-based β-blockers, sodium-glucose cotransporter 2 inhibitor, preferably angiotensin receptor/neprilysin inhibitor, and mineralocorticoid receptor antagonist-it is underutilized. IMPLEMENT-HF is a multiregional HF quality improvement initiative to improve care and outcomes for patients with HF by enhancing the use of QMT in routine practice.

Pulmonary embolism is a common cause of cardiovascular-associated morbidity and mortality. Although pulmonary embolism affects individuals from all demographics, the incidence of pulmonary embolism is higher among people from certain racial groups, reproductive-age women compared with age-matched men, and transgender people taking estrogen hormones. Furthermore, disparities may exist in the diagnosis or management strategies of pulmonary embolism associated with race, ethnicity, sex, or socioeconomic status, which may correlate with poorer downstream outcomes, including recurrent pulmonary embolism, chronic thromboembolic pulmonary hypertension, or short- or long-term mortality. This scientific statement summarizes disparities in diagnosis, treatment strategies, and outcomes related to pulmonary embolism, and reviews approaches to create equitable pulmonary embolism care and address the knowledge gaps in the literature.

Many patients with atrial functional mitral regurgitation are not suitable candidates for surgery or transcatheter repair. For transcatheter mitral valve replacement, a common contraindication is the risk of left ventricular outflow tract obstruction, particularly in patients with atrial functional mitral regurgitation, who have characteristically small left ventricles. Herein, we examine the outcomes of transcatheter mitral valve replacement using the AltaValve system, which employs atrial fixation thus minimizing left ventricular outflow tract obstruction risk.

Radiation exposure is one of the most adverse occupational hazards faced by interventional cardiologists. Various arterial access sites have shown to yield different operator radiation exposure during diagnostic cardiac catheterization.

The field of cardio-oncology has expanded over the past 2 decades to address the ever-increasing issues related to cardiovascular disease in patients with cancer and survivors. There is increasing recognition that nearly all cancer treatments pose some short- or long-term risk for development of cardiovascular disease and that pediatric patients with cancer may be especially vulnerable to cardiovascular disease because of young age at treatment and expected long life span afterward. Anthracycline chemotherapy and chest-directed radiotherapy are the most well-studied cardiotoxic therapies, and dose reduction, use of cardioprotection for anthracyclines, and modern radiotherapy approaches have contributed to improved cardiovascular outcomes for survivors. Newer treatments such as small-molecule inhibitors, antibody-based cytotoxic therapy, and immunotherapy have expanded options for previously difficult-to-treat cancers but have also revealed new cardiotoxic profiles. Application of effective surveillance strategies in patients with cancer and survivors has been a focus of practitioners and researchers, whereas the prevention and treatment of extant cardiovascular disease is still developing. Incorporation of new strategies in an equitable manner and appropriate transition from pediatric to adult care will greatly influence long-term health-related outcomes in the growing population of childhood cancer survivors at risk for cardiovascular disease.

Neonates with hypoplastic left heart syndrome variants with an intact or highly restrictive atrial septum (HLH-IAS) require immediate postnatal intervention to survive. Emergent left atrial decompression (LAD) via a percutaneous or hybrid approach is standard, but the comparative effectiveness and outcomes of these approaches remain underexplored.

With the expansion of indications for mitral transcatheter edge-to-edge repair into nondegenerative etiologies, it is unknown whether changes in technical success and clinical outcomes have occurred.

The optimal strategy for lower extremity revascularization (surgical bypass versus endovascular intervention) in patients with chronic limb-threatening ischemia (CLTI) is unclear. We examined the effectiveness of open surgical bypass using single-segment great saphenous vein conduit (SSGSV), alternative conduits (AC), or endovascular interventions (ENDO) among patients with CLTI deemed acceptable for either open surgical bypass or ENDO treatment.

Ineligibility for surgical revascularization is increasingly prevalent and associated with increased mortality after percutaneous coronary intervention (PCI). High-quality, contemporary, multicenter data regarding clinical outcomes after PCI is scarce and poses a barrier to clinical decision-making for surgically ineligible patients. The aim of this study was to describe and compare the clinical characteristics, institutional variation, and longitudinal outcomes of PCI among surgically eligible and ineligible patients in the Veterans Affairs Healthcare System.

Although patients with high bleeding risk (HBR) often have complex coronary artery lesions, it is not known whether intravascular imaging-guided percutaneous coronary intervention (PCI) improves their prognosis. We sought to investigate the benefit of intravascular imaging-guided PCI for complex coronary artery lesions in patients with HBR.