Severe congestive heart failure. How successful are drug and transplant therapies?

Severe congestive heart failure is a fatal illness. Aggressive use of proven medical regimens, including vasodilators and angiotensin-converting enzyme inhibitors, may prolong survival time for some patients. Those with refractory symptoms and seriously reduced left ventricular function, impaired exercise capacity, and complex or frequent ventricular arrhythmias should be considered for cardiac transplantation. Candidacy for transplantation is based on the absence of other illnesses that would limit survival or diminish the likelihood of success of the transplant. With the introduction of potent immunosuppressive agents, particularly cyclosporine (Sandimmune), survival rates after transplantation have improved to 90% at 1 year. Major problems include organ rejection, serious infection, development of coronary artery disease in the transplanted heart, and the limited donor organ supply.