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[Heart transplantation, cardiomyoplasty or artificial heart?]
1Clinique de chirurgie thoracique cardiaque et vasculaire, CHU de Nantes, hôpital G. et R. Laennec, Nantes.
Insights
The review of cardiac transplantation, cardiomyoplasty, and artificial hearts in 1993 shows transplantation is mature but stagnant. Cardiomyoplasty shows promise but has limitations, while artificial hearts offer temporary circulatory assistance.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Review of the state-of-the-art in cardiac replacement therapies as of 1993.
- Analysis of cardiac transplantation, cardiomyoplasty, and artificial hearts.
- Discussion of the limitations and future prospects of these advanced cardiac treatments.
Purpose of the Study:
- To evaluate the efficacy and limitations of cardiac transplantation, cardiomyoplasty, and artificial hearts.
- To discuss the challenges and potential future developments in cardiac assist devices and transplantation.
- To provide a comprehensive overview of advanced cardiac treatment options available in 1993.
Main Methods:
- Literature review of cardiac transplantation, cardiomyoplasty, and artificial heart technologies.
- Analysis of clinical outcomes, surgical indications, and patient survival rates.
- Discussion of technological challenges, economic factors, and future research directions.
Main Results:
- Cardiac transplantation showed stagnation in annual operations and limited progress, despite excellent functional rehabilitation.
- Cardiomyoplasty presented an attractive concept with difficult indications, delayed efficacy, and comparable mortality/survival rates to transplantation.
- Artificial hearts served as essential temporary circulatory assistance devices with rapidly evolving technology and significant clinical management challenges.
Conclusions:
- Cardiac transplantation had reached a plateau, with immunosuppression remaining a key challenge.
- Cardiomyoplasty required further evaluation and refinement, particularly regarding its indications and objective results.
- Artificial heart technology was promising but faced hurdles in energy sources, cost, and clinical management, particularly coagulation issues.
Abstract:
This is a difficult question and the answer is uncertain. The authors review the state of the art of the three methods in 1993. Cardiac transplantation seems to have attained its maturity. The annual number of transplant operations is stagnant and the results progress little. Functional rehabilitation is excellent, the essential immunosuppression which has not changed in principle over the last 12 years, remains prejudicial. Cardiomyoplasty is an attractive concept with difficult surgical indications (Stage III, moderately dilated cardiomyopathy with good right ventricular function without arrhythmias, pulmonary hypertension or mitral regurgitation), a delayed efficacy, a hospital mortality comparable with that of transplantation and a similar survival rate. The objective results are not as good as the more subjective functional improvement. This limited experience (about 500 patients in 50 centers throughout the world, 70% of whom are European) should be continued and evaluated in the centers which initiated it. The artificial heart is only a temporary though essential therapeutic option in certain extremely urgent situations. It is a form of circulatory assistance, ranging from the simple univentricular accessory pump to the univentricular (Novacor) or biventricular (Jarvik) heart, in a rapidly evolving technology with problems of energy sources, marketing, cost and also clinical management which is often difficult especially with respect to coagulation. What do the next ten years hold in store for us? A nex immunosuppressor or the xenograft? A more efficient cardiomyoplasty with more precise medications? A totally implantable autonomous artificial heart? Can economic considerations accompany this development? This is undoubtedly the deepest source of concern for the future.