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[Ischemic cardiomyopathy--transplantation and bridging with mechanical assist systems]
1Heinrich-Heine-Universität Düsseldorf Klinik für Thorax- und Kardiovaskulare Chirurgie.
Insights
Ischemic cardiomyopathy cases have tripled, increasing heart transplant demand. Bridging systems like implantable ventricles offer full patient mobilization and good long-term outcomes, improving transplant eligibility.
Area of Science:
- Cardiology
- Transplantation Medicine
- Mechanical Circulatory Support
Background:
- Ischemic cardiomyopathy and chronic heart failure are rising, becoming the leading cause for heart transplantation.
- A significant gap exists between donor hearts and patient need, leading to extended waiting times.
- Bridging therapy with mechanical support is increasingly utilized for patients awaiting heart transplantation.
Purpose of the Study:
- To evaluate the long-term outcomes of heart transplantation in patients bridged with mechanical support.
- To assess the role of implantable ventricles in improving patient candidacy for heart transplantation.
Main Methods:
- Review of clinical data for patients with ischemic cardiomyopathy undergoing heart transplantation.
- Analysis of long-term survival and functional status in patients who received bridging therapy.
- Assessment of the impact of mechanical circulatory support devices on patient mobility and quality of life.
Main Results:
- Long-term results after heart transplantation are comparable for patients who received bridging therapy versus those who did not.
- Implantable ventricles facilitate full patient mobilization, leading to high clinical acceptance.
- Improved experience with mechanical support and devices enhances patient suitability for transplantation.
Conclusions:
- Mechanical circulatory support, particularly implantable ventricles, is a viable and effective strategy for patients with advanced ischemic cardiomyopathy awaiting heart transplantation.
- Bridging therapy improves the condition of patients, making them better candidates for heart transplantation and achieving good long-term outcomes.
- Advancements in mechanical support technology and clinical experience are crucial for optimizing outcomes in this patient population.
Abstract:
The number of patients with ischemic cardiomyopathy and accompanying chronic pump failure of the left and/or right ventricle has tripled within the last 10 years. Ischemic cardiomyopathy represents numerically the greatest share as the reason for illness in heart transplantation today; their results are not different for patients following cardiac transplantation due to primary cardiomyopathy. Since heart transplantation has become a clinical routine method today, the discrepancy between the number of the available donor organs and the number of the needed organs becomes more and more obvious. The longer waiting lists and the longer waiting times are responsible for the increased use of bridging systems. Today the long-term results after heart transplantation are not worse in patients after bridging. With more experience in the field of mechanical support, better devices, and proved indications, frequent improvement of prerequisites for transplantation can be achieved in this group of patients. The implantable ventricles give the patient the change of full mobilization and, therefore, high clinical acceptance of this management can be registered.