2020 UAB Cardiovascular Institute Annual Report CVI Annual Report 2019-2020 6

LUNG & COMBINED HEART-LUNG Lung and combined heart-lung transplants at UAB are part of an integrated program in advanced lung disease and end-stage respiratory failure. Indications for transplant include interstitial lung disease, pulmonary hypertension, cystic fibrosis, acute lung injury, and COPD. The program has particular strengths in salvage therapy using ambulatory ECMO as a bridge to transplant in patients with fulminant heart and lung disease that is refractory to conventional medical management. In 2019, five patients (one of them pediatric) received combined heart and double lung transplants from an ambulatory ECMO bridge. UAB LUNG TRANSPLANT 1- AND 3-YEAR PATIENT SURVIVAL MECHANICAL CIRCULATORY SUPPORT: VADS & TOTAL ARTIFICIAL HEARTS The UAB ventricular assist device (VAD) program began in 1989 with the first implantation of a pneumatic extracorporeal device as a bridge to heart transplant. Since 2000, nearly 700 devices have been implanted at UAB as both destination therapy and as a bridge to transplant for patients with refractory end-stage heart disease. Two-year survival is approximately 83%, and in 2019, the VAD program once again was certified by The Joint Commission. The institution has a long history of clinical research focused on survival, functional status, and quality of life, which fosters a continual assessment of the evolving technology and optimal patient outcomes. With the inception of the total artificial heart (Syncardia TAH) program in 2016, UAB provides the full cadre of durable technologies to support the failing heart (HeartWare and Heartmate 3 LVADs), as well as short-term (non-durable) percutaneous devices (Impella and TandemHeart) as bridges to myocardial recovery. UAB Medicine’s pediatric cardiac transplant and mechanical circulatory support programs continue a tradition of national leadership at Children’s of Alabama with the Berlin Heart mechanical support device. EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) & EXTRACORPOREAL LIFE SUPPORT The UAB ECMO service is part of an institutional program in mechanical circulatory support. The program supports more than 100 patients annually and serves as a regional referral center for patients with acute lung injury and cardiogenic shock. In addition to advanced research initiatives focused on therapies to support failing organ systems (eg. ex vivo lung perfusion), the program is an active center for both “bridge to recovery” and “bridge to transplant”. The UAB ECMO program participates with the Extracorporeal Life Support Organization (ELSO) and in 2019 received the Gold Level Award for Excellence. The award recognizes ECMO programs worldwide that distinguish themselves by establishing processes, procedures, and systems to promote excellence and exceptional care. For emergency referrals, please call 205-934-4011 for the on-call ECMO physician. 20 UAB Cardiovascular Institute Annual Report CARDIAC XENOTRANSPLANTATION UAB Medicine created a world-class center for xenotransplantation, which refers to the transfer of organs, cells, and/or tissues between species. We recruited Christopher McGregor, MD – an internationally renowned cardiothoracic surgery pioneer and researcher from the University College London, St. Bartholomew’s Heart Center in London, and Mayo Clinic – to lead the cardiac xenotransplantation program. Joining Dr. McGregor is Guerard Byrne, PhD, an internationally recognized expert and an accomplished, creative scientist with extensive research experience in the area of immunobiology in xenotransplantation. Transplantation therapy for end-stage organ disease is limited by the shortage of donor organs, so transplanting kidneys, hearts, livers, and other organs into humans from large animals such as pigs could save thousands of lives per year. Cardiac xenotransplantation (CXTx) is a promising, near-term approach to the treatment of end- stage heart failure that may provide a solution to the ongoing shortage of donor hearts. UAB Medicine has an extensive and successful program for utilizing mechanical circulatory support devices to support patients with end-stage heart failure. With the recruitment of Dr. McGregor, additional alternative therapies soon may exist. PERT & CHRONIC THROMBOEMBOLIC DISEASE The UAB Pulmonary Embolism Response Team (PERT) is a multidisciplinary team designed to offer a wide range of therapeutic modalities to patients with life-threatening pulmonary embolism, acute RV failure, and chronic thromboembolic disease. Aside from anticoagulation and systemic thrombolysis, we offer a number of percutaneous therapies as well as extracorporeal life support and surgical pulmonary embolectomy for acute PE and pulmonary endarterectomy for patients with chronic thromboembolic disease. Since its start in August 2018, we have helped care for over 130 patients with higher risk pulmonary embolism. Patients are referred to a dedicated post-pulmonary embolism clinic in order to provide long-term specialized care. THORACIC TRANSPLANTATION & MECHANICAL CIRCULATORY SUPPORT Surgical pulmonary thromboendarterectomy specimen from a patient with recurrent PE and pulmonary hypertension CARDIOLOGY PULMONARY CRITICAL CARE HEMATOLOGY PERT INTER- VENTIONAL RADIOLOGY CARDIO- VASCULAR SURGERY EMERGENCY MEDICINE uabmedicine.org 21

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