Transplantation and artificial organs

Development of the Organizational Model for Organ Donation Coordination in Ukraine to Increase the Satisfaction of Patients’ Needs for Transplantation-Based Medical Care

D. M. Koval — Mon, 15 Dec 2025 00:00:00 +0200

The article analyzes the current state of the transplantation system in Ukraine, identifies key organizational problems that limit the development of deceased organ donation, and substantiates the need to transform the existing model of transplantation activity coordination. It has been proven that the current system of organizing the identification of potential donors through contractual relationships between transplant centers and healthcare facilities creates prerequisites for conflicts of interest and violation of the principle of equal access of recipients to donor organs. Based on the analysis of the experience of European Union countries, particularly the Spanish transplantation model, it is proposed to create a regional network of coordination centers as structural units of the national transplant coordination institution. An organizational model has been developed that provides for the establishment regional centers with clearly defined functionality for monitoring potential donors, organizational and methodological support for the brain death diagnosis procedure, donor conditioning, communication with relatives of the deceased, and logistical support for the donation process. The economic efficiency of the proposed model is substantiated and the expected results of its implementation are determined, which include an increase in the level of deceased organ donation from 3,68 to 10–15 per 1 million population within three years, which will increase the level of satisfaction of patient needs for organ transplantation from 15% to 50–60%.

Treatment of Heart Failure in Patients with Ischemic Cardiomyopathy Using Cell Therapy

O. Usenko, A. Gabriyelyan, V. Smorzhevskyi, I. Kudlai, O. Marchenko — Mon, 15 Dec 2025 00:00:00 +0200

Objective. Investigate the effect of cord blood stem cells on the course of heart failure in patients with ischemic cardiomyopathy.

Materials and methods. The study included 113 patients with ischemic cardiomyopathy comparable in age, sex, and basic clinical parameters. Patients were divided into four groups depending on the treatment methods: coronary artery bypass grafting (CABG) – 35 patients (33%), coronary stenting (CS) – 38 patients (31%), coronary revascularization and stem cells transplantation (CR+SCT) – 20 patients (18%), medical treatment (MT) – 20 patients (18%). The observation period was 48 months.

Results. During the first year of the study, the mean LVEF increased by 1.7 times for the CR+SCT group (from 24.8% before treatment to 37.2% after 1 year and 31.9% after 4 years). BNP results changed from a baseline of 998 pg/ml after 12 months to 377 pg/ml. After further stabilization over the next three years, BNP results stabilized at 382 pg/ml. The quality of life of patients improved (confirmed by the results of the Minnesota questionnaire). At the beginning of the study, the total score for patients was 56.8, and after 48 months, it decreased to 46.1 for the CR 46.1, compared with other groups (CABG – 55.8; CS – 55.2; MT – 62.8).

Conclusion. The use of stem cell transplantation in combination with coronary revascularization in patients with ischemic cardiomyopathy contributes to the improvement of the clinical course of the disease, an increase in LVEF, a decrease in the severity of heart failure symptoms, and an improvement in the quality of life of patients. The results obtained confirm the feasibility and prospects of using cell technologies in this category of patients.

Cardiogenic Shock: Pathophysiological Labyrinth and Exit Strategies

O. O. Tanska — Mon, 15 Dec 2025 00:00:00 +0200

Aim. Risk-stratifying patients with cardiogenic shock (CS) is a major unmet need. The recently proposed Society for Cardiovascular Angiography and Interventions (SCAI) staging system for CS severity lacks uniform criteria defining each stage.

Objectives. The purpose of this study was to test parameters that define SCAI stages and explore their utility as predictors of in-hospital mortality in CS.

Methods. The CS Working Group registry includes patients from 17 hospitals enrolled between 2016 and 2021 and was used to define clinical profiles for CS. We selected parameters of hypotension and hypoperfusion and treatment intensity, confirmed their

association with mortality, then defined formal criteria for each stage and tested the association between both baseline and maximum Stage and mortality.

Conclusions. We report a novel approach to define SCAI stages and identify a significant association between baseline and maximum stage and mortality. This approach may improve clinical application of the staging system and provides new insight into the trajectory of hospitalized CS patients. (Cardiogenic Shock Working Group Registry.

First Experience with the LVAD CorHeart 6 System in Ukraine: A Bridge to Heart Transplantation (BTT), Preliminary 4-Month Results

Volodymyr G. Tanskyi — Mon, 15 Dec 2025 00:00:00 +0200

Aim. The range of mechanical circulatory support (MCS) devices used for two-stage heart transplantation (HT) is quite wide – starting from the implantation of an artificial heart (TAH), biventricular bypass (BiVAD), left ventricular bypass (LVAD) and ending with the connection of an extracorporeal membrane oxygenation (ECMO) system. The duration of use of these technologies depends on the chosen MCS method. In particular, LVAD using implanted pumps involves long-term connection of the systems (from a month to several years). The advantage of such systems is the ability for the patient to leave the clinic and maintain an active lifestyle.

Objective. We present the first experience of implantation of the CorHeart 6 LVAD system in Ukraine. We retrospectively collected preoperative information, treatment course, and clinical outcomes.

Conclusions. LVAD systems are the most effective "bridge" to transplantation, because:

- unload damaged ventricles of the heart: reduce the size, volume and mass of the ventricles;

- provide effective circulatory support;

- preserve and improve the functioning of organs and systems,

- prevent the development of complications of CHF;

- increase survival, significantly improve the quality of life and functional status of patients compared to drug therapy.

Cardiac Resynchronization Therapy in Patients With Heart Failure and Left Bundle Branch Block

D. V. Polishchuk, S. Yu. Nakonechnyi, O. V. Molodan, O. S. Nykonenko — Mon, 15 Dec 2025 00:00:00 +0200

The purpose. To determine the efficacy, safety, and potential advantages of two variants of cardiac resynchronization therapy–biventricular pacing CRT(D) and selective left bundle branch pacing (LBBP) – in patients with left bundle branch block (LBBB) and heart failure.

Materials and Methods. In the first group, cardiac resynchronization therapy devices (CRT-(D)) were implanted in 24 patients using the standard biventricular pacing technique. The patients were aged 36 to 72 years; 20 were male and 4 were female. Three leads were positioned in the heart chambers: the atrial lead in the right atrial appendage, ventricular leads in the interventricular septum or apex, and in a lateral cardiac vein to stimulate the left ventricle in the region of maximal electromechanical delay. In the second group, 26 patients aged 16 to 75 years (21 males, 5 females) underwent selective left bundle branch pacing (LBBP). Transseptal selective LBBP was performed using an active-fixation lead (Selekt Secure, 69 cm) and a C315HIS delivery system. Central cardiohemodynamic parameters–end-systolic volume (ESV), end-diastolic volume (EDV), and left ventricular ejection fraction (LVEF) by Simpson’s method, as well as pulmonary artery pressure–were assessed by transthoracic echocardiography (TTE). The effectiveness of ventricular resynchronization was evaluated using speckle-tracking

echocardiography. The following parameters were calculated: left ventricular longitudinal strain (4-chamber view), circular strain at the basal and apical segments, and the time to peak systolic contraction of LV segments (MOWD). Changes in QRS morphology after resynchronization therapy in both groups were assessed using standard ECG. A 6-minute walk test was performed before surgery and at 3, 6, and 12 months post-procedure to evaluate the distance covered at a comfortable walking pace on a flat surface.

Results. The observation period lasted 12 months. After standard biventricular resynchronization pacing, QRS duration decreased by 21%, from 158 ± 7.1 ms to 125.3 ± 5.1 ms (St–R interval 115 ± 5.1 ms). After selective LBBP, the St–R interval was 82.3 ± 7.1 ms, representing a 47% reduction in QRS duration compared with baseline. Changes in central hemodynamic parameters over 12 months were as follows: in the first group (CRT-D), LVEF increased from 27.3 ± 3.8% to 45.2 ± 4.3%; in the second group (LBBP), LVEF increased from 39.3 ± 3.8% to 48.5 ± 3.2%. This corresponds to a 40% and 18% increase in LVEF in the first and second groups, respectively. A reduction in EDV of 28% (from 265.2 ± 14.7 to 191.3 ± 14.4 ml) was observed in the first group, and an 11.8% reduction (from 203.2 ± 13.4 to 179.3 ± 12.9 ml) in the second group. Hemodynamic improvements also included reductions in ESV: 36.5% (from 148.2 ± 3.4 to 94.2 ± 3.37 ml) and in systolic pulmonary artery pressure by 43.3% (from 30.3 ± 4.1 to 23.2 ± 3.8 mmHg) in the first group. In the second group, ESV decreased by 25.2% (from 127.5 ± 2.7 to 95.4 ± 3.1 ml),

and systolic pulmonary artery pressure decreased by 14% (from 37.4 ± 3.9 to 32.4 ± 3.5 mmHg). Speckle-tracking echocardiography demonstrated significant improvement in left ventricular deformation patterns–both longitudinal and circumferential–in both groups. Conclusion. Both techniques are effective in restoring left ventricular contractility and can be used in this group of patients. However, there are inherent advantages of direct bundle branch block pacing: it significantly shortens QRS duration, as our results showed, there were no failed electrode placement attempts, which even required thoracotomy with

biventricular pacing. Left bundle branch block pacing offers several potential advantages over biventricular pacing , including lower pacing thresholds, no atrial capture, and less technical complexity.