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Heart transplantation: how to select patients? What are the alternatives?
1Department of Cardiology, University Hospital Antwerp, Edegem, Belgium. Viviane.Conraads@uza.be
Insights
The growing shortage of donor hearts necessitates careful selection of heart transplant candidates. Advanced mechanical circulatory support devices offer promising alternatives for patients with end-stage heart failure.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Devices
Background:
- The demand for cardiac grafts significantly exceeds donor heart availability, creating a critical gap.
- Careful selection of heart transplant candidates is essential to identify patients most likely to benefit.
- End-stage heart failure patients face challenges due to transplant limitations and waiting list mortality.
Purpose of the Study:
- To outline the comprehensive evaluation process for heart transplant candidates.
- To highlight the importance of excluding irreversible pulmonary hypertension and other contraindications.
- To discuss the evolution and role of mechanical circulatory support devices as alternatives.
Main Methods:
- Comprehensive cardiac and systemic evaluation of potential heart transplant recipients.
- Assessment for irreversible pulmonary hypertension as a critical exclusion criterion.
- Review of current and emerging mechanical devices for heart failure management.
Main Results:
- Rigorous patient work-up is crucial for optimal heart transplant candidate selection.
- Exclusion of specific conditions like pulmonary hypertension is vital for successful outcomes.
- Mechanical devices, including left ventricular assist devices and biventricular pacemakers, are advancing rapidly.
Conclusions:
- Optimizing heart transplant candidate selection is paramount due to donor organ scarcity.
- Mechanical circulatory support devices represent a significant advancement in treating advanced heart failure.
- These devices are transitioning from experimental to established therapeutic options.
Abstract:
The gap between the number of potential recipients of a cardiac graft and the availability of donor hearts is still growing. A proper selection of heart transplant candidates is mandatory to ensure that patients in critical need, who are likely to benefit from this procedure, are identified. The work-up of a patient with terminal chronic heart failure includes a comprehensive cardiac and systemic evaluation. Critical in the decision is the exclusion of irreversible pulmonary hypertension. Furthermore, underlying diseases that could compromise short- and long-term prognosis after transplantation should be carefully assessed. The mortality on the waiting list and the growing pool of patients with chronic heart failure that is excluded from transplantation has stimulated the search for alternative treatment modalities. Besides a pharmacologic approach, the last few years have witnessed a tremendous evolution in so-called mechanical devices, designed to improve both morbidity and mortality of these patients. Although several of these devices have only just entered the clinical phase, internal cardioverter defibrillators, left ventricular assist devices and biventricular pacemakers can no longer be viewed as experimental tools.
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