Heart transplantation, assist devices, and cardiomyoplasty

Allograft replacement of the heart in pediatric patients has gained growing interest within the spectrum of cardiac transplantation. Here and in other age groups, new immunosuppressive agents are under investigation, hopefully providing more selective reduction of the immune response with lower side effects compared with conventional therapy. Many clinical investigators and basic scientists are working to understand, prevent, and possibly treat chronic cardiac allograft rejection, one of the major threats in long-term survivors. Within the scope of mechanical assist device application, bridge to transplantation does provide the best results. New developments include emergency treatment of cardiogenic shock by an intravascular left ventricular assist device and cardiopulmonary bypass, both designed as life support systems. Clinical studies on permanent implants of ventricular assist devices are on the way. As another alternative to heart transplantation, dynamic cardiomyoplasty using the latissimus dorsi muscle has gained increasing clinical attention. Results relating to clinical and hemodynamic improvement, however, remain conflicting, and long-term results are not yet available.