Welcome to this special supplement devoted to the proceedings of the 6th Annual Acute Cardiac Unloading and Recovery (A-CURE) Working Group meeting, which was held virtually on 28 January 2022 (https://a-cure.org/a-cure-symposium/). The A-CURE Working Group is comprised of leading academic experts in clinical and basic cardiac research who are dedicated to advancing the science and clinical application of acute cardiac unloading. This meeting brought together experts from various disciplines, including interventional cardiologists, heart failure specialists, cardiac surgeons, molecular biologists and biomedical engineers.
The A-CURE symposium is a platform to promote discussion of the latest discoveries in the field of ventricular unloading and heart recovery. The 2022 symposium featured invited talks and abstract presentations that highlighted cutting-edge advances in the field of acute cardiac unloading with a special focus on topics of heart recovery and novel surgical applications of mechanical circulatory support (MCS).
This supplement features 21 presentations covering a broad range of subjects related to cardiac unloading. Dr Dan Burkhoff opened the symposium with his state-of-the-field address highlighting the achievements of two recent Nobel Laureates, Dr Gregg Semenza from 2019 and Dr Ardem Patapoutian from 2021, whose work had immediate relevance to mechanisms of unloading. The first session focused on advances in basic and preclinical science of acute unloading and myocardial salvage, featuring six abstract winners with state-of-the-art preclinical works in acute MI (AMI), cardiac arrest, right ventricular failure, extracorporeal membrane oxygenation and concomitant Impella support (ECPELLA) and novel percutaneous ventricular assist devices. Dr Renata Mazurek, the 2022 Young Investigator Award recipient, closed the session with her talk on the importance of a weaning protocol with MCS use in revascularisation.
This supplement contains summaries from three invited lectures. For the Innovation Lecture, Dr Navin Kapur discussed the past, present and future of the field’s understanding of the molecular mechanisms of unloading. He emphasised the growing body of knowledge supporting the understanding that molecular changes in the myocardium directly inform a patient’s ability to recover. There are several research arenas, such as mitochondrial integrity and calcium cycling, that Dr Kapur believes will provide new insight into optimising cardiac unloading and recovery. This dovetailed with the Keynote Lecture by Dr Clyde Yancy, who highlighted the benefits of a holistic approach to treating advanced heart failure. Dr Yancy’s wide-ranging discussion underscored the growing consensus in the field of unloading that there must be a robust understanding of both the physical and molecular changes to the myocardium in heart failure (HF). He posited this will lead to better therapeutic avenues and options, which will likely include varying combinations of unloading devices and drug therapy, tailored to the patient’s biology. This year’s Distinguished Lecture was given by Dr Emma Birks, an internationally recognised expert in HF recovery. Dr Birks provided an in-depth review of her discoveries in the Remission from Stage D Heart Failure (RESTAGE-HF) trial, which revealed that unloading combined with customised pump support and aggressive drug therapy can result in durable, long-term recovery in HF patients.
The second session featured real-world applications of acute ventricular unloading. Dr Tharusan Thevathasan, the Best in Research Award recipient, opened the session with a presentation on ECPELLA outcomes in the cardiac arrest patient population. Top physician scientists from Europe and the US presented findings from recently completed and ongoing clinical trials testing innovative clinical applications of ventricular unloading in myocarditis, high-risk percutaneous coronary intervention, AMI cardiogenic shock and ST-elevation MI. This was followed by the third session, which highlighted the new frontiers in surgical and clinical applications of unloading. Upcoming clinical studies of MCS in cardiac and non-cardiac surgery were presented by four renowned cardiac surgeons. The last session addressed the topic of clinical science and evidence of cardiac recovery. Led by leading experts in heart recovery and advanced HF programs, the symposium closed with discussions on the fundamentals of heart recovery versus remission, a real-world heart recovery program and a new percutaneous MCS device designed for bridge-to-recovery applications in the HF space.
In addition to the live talks, 38 scientific posters were accepted for A-CURE 2022 from top-class researchers around the world. The posters can be viewed at the A-CURE website (https://www.posterpresentations.com/research/groups/acure/acure.html). The presentations this year highlighted exciting new developments and represented substantial advances in the field of acute myocardial unloading and heart recovery over the past year. The A-CURE Working Group meeting is unique in including a diverse group of experts from various disciplines within an open, constructive and intimate public setting.
We hope that you find this supplement informative and interesting.