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Selecting candidates for cardiac transplantation. How to assess exclusion criteria and predict who will benefit
P R Rickenbacher1, G Haywood, M B Fowler
1Division of Cardiovascular Medicine, Stanford University School of Medicine, USA.
Insights
Advanced heart failure unresponsive to treatment is the primary reason for heart transplantation. Other conditions may also be indications, but determining true refractoriness to therapy is complex and requires more than ejection fraction or acute status.
Area of Science:
- Cardiology
- Transplantation Medicine
Background:
- Advanced heart failure significantly impacts patient prognosis.
- Medical therapy is the first line of treatment for heart failure.
- Cardiac transplantation is a life-saving option for end-stage heart failure.
Purpose of the Study:
- To outline the primary and secondary indications for cardiac transplantation.
- To highlight the challenges in determining refractory heart failure for transplant candidacy.
Main Methods:
- Review of established criteria for cardiac transplantation.
- Analysis of patient conditions and treatment responses.
Main Results:
- The main indication for cardiac transplantation is advanced heart failure refractory to medical therapy, particularly in patients with coronary artery disease or dilated cardiomyopathy.
- Other indications include advanced valvular/congenital heart disease and rare cardiomyopathies, inflammatory conditions, or cardiac tumors.
- Assessing true refractoriness to medical therapy is challenging and cannot rely solely on ejection fraction or acute clinical status.
Conclusions:
- Cardiac transplantation is reserved for end-stage heart failure unresponsive to optimal medical management.
- Careful patient selection is crucial, requiring comprehensive evaluation beyond basic clinical or functional metrics.
Abstract:
The fundamental indication for cardiac transplantation is advanced heart failure that is unresponsive to medical therapy in patients with coronary artery disease or dilated cardiomyopathy. Other potential indications include advanced valvular or congenital heart disease and, more rarely, hypertrophic or restrictive cardiomyopathy, sarcoidosis, myocarditis, and primary unresectable cardiac tumors. Determining which patients have symptoms that are truly refractory to medical therapy is difficult. Ejection fraction or clinical status during acute decompensation is not a sufficient criterion for candidacy.