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Selection of patients and techniques of heart transplantation
James K Kirklin1, David C McGiffin, Laura J Pinderski
1Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA. jkirklin@UAB.edu
Insights
Cardiac transplantation is a key treatment for advanced heart failure. Patient selection for heart transplant should balance survival benefits with quality of life, favoring the bicaval technique.
Area of Science:
- Cardiology
- Transplantation Surgery
Background:
- Advanced heart failure necessitates advanced treatment options.
- Cardiac transplantation is the leading therapy for select patients under 65.
- Medical management alone is insufficient for symptomatic patients.
Purpose of the Study:
- To define criteria for optimal cardiac transplant recipient selection.
- To emphasize the balance between survival benefit and quality of life.
- To recommend the preferred surgical technique for cardiac transplantation.
Main Methods:
- Review of outcomes research in advanced heart failure.
- Analysis of survival and quality of life data for various therapies.
- Evaluation of patient comorbidities in transplant candidacy.
Main Results:
- Cardiac transplantation offers significant benefits for carefully selected patients.
- Patient selection must consider predicted long-term survival and quality of life.
- The bicaval technique is recommended for most cardiac transplant recipients.
Conclusions:
- Cardiac transplantation is a vital option for advanced heart failure.
- Recipient selection requires careful consideration of individual patient factors.
- The bicaval technique is the preferred method for cardiac transplantation, with exceptions for pediatric cases.
Abstract:
Cardiac transplantation remains the primary therapeutic choice for most patients under 65 years of age with advanced heart failure who remain symptomatic despite maximal medical therapy. Cardiac transplantation should be reserved for those patients most likely to benefit in terms of both life expectancy and quality of life. The concept of survival benefit margin must be balanced with the principles of utility in the selection process. A critical component of outcomes research for advanced heart failure will be the generation of accurate data and analyses which predict long-term survival and quality of life with various therapeutic modalities. Patients with multiple comorbidities have inferior survival and might be considered for alternative therapies. We currently recommend the bicaval techniques as the transplant technique of choice except in small infants and children.
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