Scott C Silvestry

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Journals/Publications

• D'Alessandro, D., Schroder, J., Meyer, D. M., Vidic, A., Shudo, Y., Silvestry, S., Leacche, M., Sciortino, C. M., Rodrigo, M. E., Pham, S. M., Copeland, H., Jacobs, J. P., Kawabori, M., Takeda, K., & Zuckermann, A. (2024). Impact of controlled hypothermic preservation on outcomes following heart transplantation. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 43(7), 1153-1161.
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  Severe primary graft dysfunction (PGD) is a major cause of early mortality after heart transplant, but the impact of donor organ preservation conditions on severity of PGD and survival has not been well characterized.
• Gosev, I., Pham, D. T., Um, J. Y., Anyanwu, A. C., Itoh, A., Kotkar, K., Takeda, K., Naka, Y., Peltz, M., Silvestry, S. C., Couper, G., Leacche, M., Rao, V., Sun, B., Tedford, R. J., Mokadam, N., McNutt, R., Crandall, D., Mehra, M. R., & Salerno, C. T. (2024). Ventricular assist device using a thoracotomy-based implant technique: Multi-Center Implantation of the HeartMate 3 in Subjects With Heart Failure Using Surgical Techniques Other Than Full Median Sternotomy (HM3 SWIFT). The Journal of thoracic and cardiovascular surgery, 168(5), 1474-1484.e12.
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  The HeartMate 3 (Abbott) left ventricular assist device provides substantial improvement in long-term morbidity and mortality in patients with advanced heart failure. The Implantation of the HeartMate 3 in Subjects With Heart Failure Using Surgical Techniques Other Than Full Median Sternotomy study compares thoracotomy-based implantation clinical outcomes with standard median sternotomy.
• Guglin, M., Hirsch, J. R., Tanawuttiwat, T., Akhtar, N., Silvestry, S., Ilonze, O. J., Gehring, R. M., & Birks, E. J. (2024). How to diagnose and manage emergency medical conditions in patients on left ventricular assist device support: A clinician's field guide. Trends in cardiovascular medicine.
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  Left ventricular assist devices (LVADs) have revolutionized the treatment of advanced heart failure, providing mechanical circulatory support for patients awaiting heart transplantation or as destination therapy. However, patients on LVAD support are susceptible to a range of emergency medical conditions that require prompt recognition, intervention, and multidisciplinary management. This review paper aims to provide an algorithmic approach and a field guide on the diagnosis and management of emergency medical conditions in LVAD patients, including LVAD alarms, gastrointestinal bleeding, cerebrovascular accidents, pump thrombosis and obstruction, unresponsiveness, and electrical shock by the defibrillator. By understanding the mechanisms, clinical presentation, diagnostic evaluation, and therapeutic strategies associated with these conditions, healthcare providers can improve patient outcomes and optimize LVAD care.
• Hoffman, J. R., Hartwig, M. G., Cain, M. T., Rove, J. Y., Siddique, A., Urban, M., Mulligan, M. S., Bush, E. L., Balsara, K., Demarest, C. T., Silvestry, S. C., Wilkey, B., Trahanas, J. M., Pretorius, V. G., Shah, A. S., Moazami, N., Pomfret, E. A., Catarino, P. A., & , I. c. (2024). Consensus Statement: Technical Standards for Thoracoabdominal Normothermic Regional Perfusion. Transplantation, 108(8), 1669-1680.
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  Thoracoabdominal normothermic regional perfusion (TA-NRP) has emerged as a powerful technique for optimizing organ procurement from donation after circulatory death donors. Despite its rapid adoption, standardized guidelines for TA-NRP implementation are lacking, prompting the need for consensus recommendations to ensure safe and effective utilization of this technique.
• Hoffman, J. R., Hartwig, M. G., Cain, M. T., Rove, J. Y., Siddique, A., Urban, M., Mulligan, M. S., Bush, E. L., Balsara, K., Demarest, C. T., Silvestry, S. C., Wilkey, B., Trahanas, J. M., Pretorius, V. G., Shah, A. S., Moazami, N., Pomfret, E. A., Catarino, P. A., , A. S., , , I. S., et al. (2024). Consensus Statement: Technical Standards for Thoracoabdominal Normothermic Regional Perfusion. The Annals of thoracic surgery, 118(4), 778-791.
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  Thoracoabdominal normothermic regional perfusion (TA-NRP) has emerged as a powerful technique for optimizing organ procurement from donation after circulatory death donors. Despite its rapid adoption, standardized guidelines for TA-NRP implementation are lacking, prompting the need for consensus recommendations to ensure safe and effective utilization of this technique.
• Hong, Y., Couper, C. D., Iyanna, N., Hess, N. R., Ziegler, L. A., Abdullah, M., Mathier, M. A., Hickey, G. W., Keebler, M. E., Silvestry, S. C., & Kaczorowski, D. (2024). Mid-term Waitlist and Posttransplant Outcomes With Hepatitis C-positive Donor Hearts. Transplantation.
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  This study evaluates the clinical trends and impact of hepatitis C virus-positive (HCV+) donors on waitlist and posttransplant outcomes after heart transplantation.
• Kwon, J. H., Bentley, D., Cevasco, M., Blumer, V., Kanwar, M. K., Silvestry, S. C., Daneshmand, M. A., Abraham, J., Shorbaji, K., & Kilic, A. (2024). Patient Characteristics and Early Clinical Outcomes With Impella 5.5: A Systematic Review and Meta-Analysis. ASAIO journal (American Society for Artificial Internal Organs : 1992), 70(7), 557-564.
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  Data regarding outcomes with Impella 5.5 are limited. The aim of this systematic review and meta-analysis was to summarize patient and treatment characteristics and early clinical outcomes among patients supported by Impella 5.5. A systematic literature search was conducted in PubMed, Scopus, and Cochrane databases from September 2019 to March 2023. Studies reporting outcomes in greater than or equal to 5 patients were included for review. Patient characteristics, treatment characteristics, and early clinical outcomes were extracted. Outcomes included adverse events, survival to hospital discharge, and 30 day survival. Random-effect models were used to estimate pooled effects for survival outcomes. Assessment for bias was performed using funnel plots and Egger's tests. Fifteen studies were included for qualitative review, representing 707 patients. Mean duration of support was 9.9 ± 8.2 days. On meta-analysis of 13 studies reporting survival outcomes, survival to hospital discharge was 68% (95% confidence interval [CI], 58-78%), and 30 day survival was 65% (95% CI, 56-74%) among patients with Impella devices predominantly supported by Impella 5.5 (>60%). There was significant study heterogeneity for these outcomes. Among 294 patients with Impella 5.5 only, survival to discharge was 78% (95% CI, 72-82%) with no significant study heterogeneity. This data present early benchmarks for outcomes with Impella 5.5 as clinical experience with these devices accrues.
• Lerman, J. B., Patel, C. B., Casalinova, S., Nicoara, A., Holley, C. L., Leacche, M., Silvestry, S., Zuckermann, A., D'Alessandro, D. A., Milano, C. A., Schroder, J. N., & DeVore, A. D. (2024). Early Outcomes in Patients With LVAD Undergoing Heart Transplant via Use of the SherpaPak Cardiac Transport System. Circulation. Heart failure, 17(5), e010904.
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  Heart transplant (HT) in recipients with left ventricular assist devices (LVADs) is associated with poor early post-HT outcomes, including primary graft dysfunction (PGD). As complicated heart explants in recipients with LVADs may produce longer ischemic times, innovations in donor heart preservation may yield improved post-HT outcomes. The SherpaPak Cardiac Transport System is an organ preservation technology that maintains donor heart temperatures between 4 °C and 8 °C, which may minimize ischemic and cold-induced graft injuries. This analysis sought to identify whether the use of SherpaPak versus traditional cold storage was associated with differential outcomes among patients with durable LVAD undergoing HT.
• Moayedifar, R., Shudo, Y., Kawabori, M., Silvestry, S., Schroder, J., Meyer, D. M., Jacobs, J. P., D'Alessandro, D., & Zuckermann, A. (2024). Recipient Outcomes With Extended Criteria Donors Using Advanced Heart Preservation: An Analysis of the GUARDIAN-Heart Registry. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 43(4), 673-680.
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  The prevalence of end-stage heart failure and patients who could benefit from heart transplantation requires an expansion of the donor pool, relying on the transplant community to continually re-evaluate and expand the use of extended criteria donor organs. Introduction of new technologies such as the Paragonix SherpaPak Cardiac Transport System aids in this shift. We seek to analyze the impact of the SherpaPak system on recipient outcomes who receive extended criteria organs in the GUARDIAN-Heart Registry.
• Nickel, I., Potapov, E., Sun, B., Zimpfer, D., Koliopoulou, A., Adachi, I., Anyanwu, A., Falk, V., Atluri, P., Faerber, G., Goldstein, D., Yarboro, L., Slaughter, M. S., Milano, C., Tsukashita, M., D'Alessandro, D., Silvestry, S., Kirov, H., Bommareddi, S., , Lanmüller, P., et al. (2024). Deactivation of LVAD support for myocardial recovery-surgical perspectives. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 43(9), 1489-1500.
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  Left ventricular assist devices (LVADs) are excellent therapies for advanced heart failure patients either bridged to transplant or for lifetime use. LVADs also allow for reverse remodeling of the failing heart that is often associated with functional improvement. Indeed, growing enthusiasm exists to better understand this population of patients, whereby the LVAD is used as an adjunct to mediate myocardial recovery. When patients achieve benchmarks suggesting that they no longer need LVAD support, questions related to the discontinuation of LVAD therapy become front and center. The purpose of this review is to provide a surgical perspective on the practical and technical issues surrounding LVAD deactivation.
• Schroder, J. N., Patel, C. B., DeVore, A. D., Casalinova, S., Koomalsingh, K. J., Shah, A. S., Anyanwu, A. C., D'Alessandro, D. A., Mudy, K., Sun, B., Strueber, M., Khaghani, A., Shudo, Y., Esmailian, F., Liao, K., Pagani, F. D., Silvestry, S., Wang, I. W., Salerno, C. T., , Absi, T. S., et al. (2024). Increasing Utilization of Extended Criteria Donor Hearts for Transplantation: The OCS Heart EXPAND Trial. JACC. Heart failure, 12(3), 438-447.
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  Extended criteria donor (ECD) hearts available with donation after brain death (DBD) are underutilized for transplantation due to limitations of cold storage.
• Silvestry, S. (2024). Discussion. The Journal of thoracic and cardiovascular surgery, 167(5), 1819-1820.
• Silvestry, S. C. (2024).

  Improved 2-Year Heart Transplant Survival with Moderate Hypothermic Donor Heart Preservation in the Guardian Heart Registry

  . Journal of Heart and Lung Transplantation. doi:10.1016/j.healun.2024.02.139
• Silvestry, S. C. (2024).

  Risk of RV Dysfunction Following Heart Transplantation: Donor Organ Temperature Matters!

  . Journal of Cardiac Failure.
• Silvestry, S. C. (2024). Commentary: Left ventricular assist device complications after heart transplantation: Then and now. The Journal of thoracic and cardiovascular surgery, 167(3), 1061-1063.
• Silvestry, S. C. (2024). Commentary: The evolving market of heart transplantation. The Journal of thoracic and cardiovascular surgery, 167(5), 1864-1865.
• Silvestry, S. C. (2024). Commentary: The search for left ventricular assist device outflow tract obstruction. The Journal of thoracic and cardiovascular surgery, 167(4), 1331-1332.
• Silvestry, S. C. (2024). Commentary: Tricuspid repair and left ventricular assist device: A new baseline. The Journal of thoracic and cardiovascular surgery, 167(5), 1821-1822.
• Silvestry, S. C. (2024). Doctor, Your Patient is the Neighborhood. Annals of surgery, 279(3), 383-384.
• Silvestry, S., Leacche, M., Meyer, D. M., Shudo, Y., Kawabori, M., Mahesh, B., Zuckermann, A., D'Alessandro, D., & Schroder, J. (2024). Outcomes in Heart Transplant Recipients by Bridge to Transplant Strategy When Using the SherpaPak Cardiac Transport System. ASAIO journal (American Society for Artificial Internal Organs : 1992), 70(5), 388-395.
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  The last several years have seen a rise in use of mechanical circulatory support (MCS) to bridge heart transplant recipients. A controlled hypothermic organ preservation system, the SherpaPak Cardiac Transport System (SCTS), was introduced in 2018 and has grown in utilization with reports of improved posttransplant outcomes. The Global Utilization And Registry Database for Improved heArt preservatioN (GUARDIAN)-Heart registry is an international, multicenter registry assessing outcomes after transplant using the SCTS. This analysis examines outcomes in recipients bridged with various MCS devices in the GUARDIAN-Heart Registry. A total of 422 recipients with donor hearts transported using SCTS were included and identified. Durable ventricular assist devices (VADs) were used exclusively in 179 recipients, temporary VADs or intra-aortic balloon pump (IABP) in 197, and extracorporeal membrane oxygenation (ECMO) in 14 recipients. Average ischemic times were over 3.5 hours in all cohorts. Severe primary graft dysfunction (PGD) posttransplant increased across groups (4.5% VAD, 5.1% temporary support, 21.4% ECMO), whereas intensive care unit (ICU) length of stay (18.2 days) and total hospital stay (39.4 days) was longer in the ECMO cohort than the VAD and IABP groups. A comparison of outcomes of MCS bridging in SCTS versus traditional ice revealed significantly lower rates of both moderate/severe right ventricular (RV) dysfunction and severe PGD in the SCTS cohort; however, upon propensity matching only the reductions in moderate/severe RV dysfunction were statistically significant. Use of SCTS in transplant recipients with various bridging strategies results in excellent outcomes.

Presentations

• Silvestry, S. C. (2024, May). Quo Vadis Mechanical Circulatory Support?. HVI Grand RoundsPenn State College of Medicine.