Heart transplantation indications: Difference between revisions
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{{Heart transplantation}} | {{Heart transplantation}} | ||
'''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]]; '''Associate Editor-In-Chief:''' {{CZ}} | '''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]]; '''Associate Editor-In-Chief:''' {{CZ}}{{IF}} | ||
== | ==Overview== | ||
Patients requiring a cardiac transplant are generally with advanced, irreversible heart failure with a severely limited life expectancy. These patients would have failed medical and device therapy. Common indications include causes that led to this like- [[systolic heart failure]] with a left ventricular [[ejection fraction]] less than 35%, [[Ischemia|ischemic]] [[coronary artery disease]] with [[Angina|refractory angina]], intractable life-threatening [[Cardiac arrhythmia|arrhythmias]], [[Cardiomyopathy|cardiomyopathies]], and [[Congenital heart disease|congenital heart disease.]] | |||
===Systolic Heart Failure with a Left Ventricular Ejection Fraction less than 35%=== | ==Indications== | ||
In order for a patient to be recommended for a heart transplant they will generally have advanced, irreversible [[heart failure]] with a severely limited [[life expectancy]].<ref name="pmid11397947">{{cite journal |author=Steinman TI, Becker BN, Frost AE, Olthoff KM, Smart FW, Suki WN, Wilkinson AH |title=Guidelines for the referral and management of patients eligible for solid organ transplantation |journal=[[Transplantation]] |volume=71 |issue=9 |pages=1189–204 |year=2001 |month=May |pmid=11397947 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0041-1337&volume=71&issue=9&spage=1189 |issn=}}</ref> It is important to note that the life expectancy of [[heart failure]] has improved over the past two decades due to improvements in both medical therapy ([[ACE Inhibition]], [[beta-blockers]], [[aldosterone antagonists]] and device therapy such as [[automatic implantable cardiac defibrillator]]s [[AICD]]s and [[cardiac resynchronization]]. Thus, patients should not be considered for cardiac transplantation unless they have failed aggressive medical and device therapy. <ref name="pmid25132979">{{cite journal| author=Alraies MC, Eckman P| title=Adult heart transplant: indications and outcomes. | journal=J Thorac Dis | year= 2014 | volume= 6 | issue= 8 | pages= 1120-8 | pmid=25132979 | doi=10.3978/j.issn.2072-1439.2014.06.44 | pmc=4133547 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25132979 }} </ref><ref name="pmid17261651">{{cite journal| author=Canter CE, Shaddy RE, Bernstein D, Hsu DT, Chrisant MR, Kirklin JK | display-authors=etal| title=Indications for heart transplantation in pediatric heart disease: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young; the Councils on Clinical Cardiology, Cardiovascular Nursing, and Cardiovascular Surgery and Anesthesia; and the Quality of Care and Outcomes Research Interdisciplinary Working Group. | journal=Circulation | year= 2007 | volume= 115 | issue= 5 | pages= 658-76 | pmid=17261651 | doi=10.1161/CIRCULATIONAHA.106.180449 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17261651 }} </ref> | |||
===Systolic Heart Failure with a Left Ventricular Ejection Fraction less than 35%<ref name="pmid26776864">{{cite journal| author=Mehra MR, Canter CE, Hannan MM, Semigran MJ, Uber PA, Baran DA | display-authors=etal| title=The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update. | journal=J Heart Lung Transplant | year= 2016 | volume= 35 | issue= 1 | pages= 1-23 | pmid=26776864 | doi=10.1016/j.healun.2015.10.023 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26776864 }} </ref>=== | |||
Due to either: | |||
*Ischemic [[cardiomyopathy]] | |||
*Dilated [[cardiomyopathy]] | |||
*[[Valvular heart disease]] | |||
*[[Hypertensive heart disease]] | |||
*''Etiologies which are excluded are [[amyloid]], [[HIV]], and cardiac [[sarcoma]]'' | |||
===Ischemic Coronary Artery Disease with Refractory Angina=== | ===Ischemic Coronary Artery Disease with Refractory Angina=== | ||
*Ischemia which is not amenable to percutaneous or surgical revascularization ([[coronary artery bypass graft surgery]] CABG) and is refractory to maximally tolerated medical and/or device therapy | |||
*Ischemia which is not amenable to percutaneous or surgical revascularization ([[coronary artery bypass graft surgery]] CABG) and is refractory to maximally tolerated medical and/or device therapy. <ref name="pmid27772668">{{cite journal| author=Lund LH, Edwards LB, Dipchand AI, Goldfarb S, Kucheryavaya AY, Levvey BJ | display-authors=etal| title=The Registry of the International Society for Heart and Lung Transplantation: Thirty-third Adult Heart Transplantation Report-2016; Focus Theme: Primary Diagnostic Indications for Transplant. | journal=J Heart Lung Transplant | year= 2016 | volume= 35 | issue= 10 | pages= 1158-1169 | pmid=27772668 | doi=10.1016/j.healun.2016.08.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27772668 }} </ref> | |||
===Intractable life-threatening Arrhythmias=== | ===Intractable life-threatening Arrhythmias=== | ||
*[[Ventricular arrhythmias]] which are not controlled by an [[implantable cardioverter-defibrillator]] and are refractory or not amenable to electrophysiologic guided single or combination medical therapy | *[[Ventricular arrhythmias]] which are not controlled by an [[implantable cardioverter-defibrillator]] and are refractory or not amenable to electrophysiologic guided single or combination medical therapy | ||
* Patients that are not a candidate for catheter ablation therapy | *Patients that are not a candidate for catheter ablation therapy. <ref name="pmid25132979">{{cite journal| author=Alraies MC, Eckman P| title=Adult heart transplant: indications and outcomes. | journal=J Thorac Dis | year= 2014 | volume= 6 | issue= 8 | pages= 1120-8 | pmid=25132979 | doi=10.3978/j.issn.2072-1439.2014.06.44 | pmc=4133547 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25132979 }} </ref> | ||
===Cardiomyopathies=== | ===Cardiomyopathies=== | ||
*Restrictive and Hypertrophic Cardiomyopathies with [[New | |||
*Restrictive and Hypertrophic Cardiomyopathies with [[New York heart association functional classification|NYHA Class IV]] [[heart failure]] symptoms that persist despite maximal medical therapy, [[myomectomy]], [[alcohol septal ablation]], [[mitral valve replacement]] | |||
*Non-dilated cardiomyopathies such as arrhythmogenic right ventricular cardiomyopathy. <ref name="pmid25132979">{{cite journal| author=Alraies MC, Eckman P| title=Adult heart transplant: indications and outcomes. | journal=J Thorac Dis | year= 2014 | volume= 6 | issue= 8 | pages= 1120-8 | pmid=25132979 | doi=10.3978/j.issn.2072-1439.2014.06.44 | pmc=4133547 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25132979 }} </ref> | |||
===Congenital Heart Disease=== | ===Congenital Heart Disease=== | ||
=== | *CHD resulting in [[New York Heart Association (NYHA) class|New York Heart Association]] functional class IV Heart Failure not amenable to surgery. | ||
*Severe symptomatic [[Congenital heart disease cyanotic|cyanotic congenital heart disease.]] | |||
*Presence of some degree of [[pulmonary hypertension]] with the potential risk of developing fixed and irreversible elevation of [[pulmonary vascular resistance]] (PVR) <ref name="pmid25132975">{{cite journal| author=Thrush PT, Hoffman TM| title=Pediatric heart transplantation-indications and outcomes in the current era. | journal=J Thorac Dis | year= 2014 | volume= 6 | issue= 8 | pages= 1080-96 | pmid=25132975 | doi=10.3978/j.issn.2072-1439.2014.06.16 | pmc=4133537 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25132975 }} </ref> | |||
==References== | ==References== | ||
Latest revision as of 23:39, 12 January 2021
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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D.; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [1]Ifrah Fatima, M.B.B.S[2]
Overview
Patients requiring a cardiac transplant are generally with advanced, irreversible heart failure with a severely limited life expectancy. These patients would have failed medical and device therapy. Common indications include causes that led to this like- systolic heart failure with a left ventricular ejection fraction less than 35%, ischemic coronary artery disease with refractory angina, intractable life-threatening arrhythmias, cardiomyopathies, and congenital heart disease.
Indications
In order for a patient to be recommended for a heart transplant they will generally have advanced, irreversible heart failure with a severely limited life expectancy.[1] It is important to note that the life expectancy of heart failure has improved over the past two decades due to improvements in both medical therapy (ACE Inhibition, beta-blockers, aldosterone antagonists and device therapy such as automatic implantable cardiac defibrillators AICDs and cardiac resynchronization. Thus, patients should not be considered for cardiac transplantation unless they have failed aggressive medical and device therapy. [2][3]
Systolic Heart Failure with a Left Ventricular Ejection Fraction less than 35%[4]
Due to either:
- Ischemic cardiomyopathy
- Dilated cardiomyopathy
- Valvular heart disease
- Hypertensive heart disease
- Etiologies which are excluded are amyloid, HIV, and cardiac sarcoma
Ischemic Coronary Artery Disease with Refractory Angina
- Ischemia which is not amenable to percutaneous or surgical revascularization (coronary artery bypass graft surgery CABG) and is refractory to maximally tolerated medical and/or device therapy. [5]
Intractable life-threatening Arrhythmias
- Ventricular arrhythmias which are not controlled by an implantable cardioverter-defibrillator and are refractory or not amenable to electrophysiologic guided single or combination medical therapy
- Patients that are not a candidate for catheter ablation therapy. [2]
Cardiomyopathies
- Restrictive and Hypertrophic Cardiomyopathies with NYHA Class IV heart failure symptoms that persist despite maximal medical therapy, myomectomy, alcohol septal ablation, mitral valve replacement
- Non-dilated cardiomyopathies such as arrhythmogenic right ventricular cardiomyopathy. [2]
Congenital Heart Disease
- CHD resulting in New York Heart Association functional class IV Heart Failure not amenable to surgery.
- Severe symptomatic cyanotic congenital heart disease.
- Presence of some degree of pulmonary hypertension with the potential risk of developing fixed and irreversible elevation of pulmonary vascular resistance (PVR) [6]
References
- ↑ Steinman TI, Becker BN, Frost AE, Olthoff KM, Smart FW, Suki WN, Wilkinson AH (2001). "Guidelines for the referral and management of patients eligible for solid organ transplantation". Transplantation. 71 (9): 1189–204. PMID 11397947. Unknown parameter
|month=ignored (help) - ↑ 2.0 2.1 2.2 Alraies MC, Eckman P (2014). "Adult heart transplant: indications and outcomes". J Thorac Dis. 6 (8): 1120–8. doi:10.3978/j.issn.2072-1439.2014.06.44. PMC 4133547. PMID 25132979.
- ↑ Canter CE, Shaddy RE, Bernstein D, Hsu DT, Chrisant MR, Kirklin JK; et al. (2007). "Indications for heart transplantation in pediatric heart disease: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young; the Councils on Clinical Cardiology, Cardiovascular Nursing, and Cardiovascular Surgery and Anesthesia; and the Quality of Care and Outcomes Research Interdisciplinary Working Group". Circulation. 115 (5): 658–76. doi:10.1161/CIRCULATIONAHA.106.180449. PMID 17261651.
- ↑ Mehra MR, Canter CE, Hannan MM, Semigran MJ, Uber PA, Baran DA; et al. (2016). "The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update". J Heart Lung Transplant. 35 (1): 1–23. doi:10.1016/j.healun.2015.10.023. PMID 26776864.
- ↑ Lund LH, Edwards LB, Dipchand AI, Goldfarb S, Kucheryavaya AY, Levvey BJ; et al. (2016). "The Registry of the International Society for Heart and Lung Transplantation: Thirty-third Adult Heart Transplantation Report-2016; Focus Theme: Primary Diagnostic Indications for Transplant". J Heart Lung Transplant. 35 (10): 1158–1169. doi:10.1016/j.healun.2016.08.017. PMID 27772668.
- ↑ Thrush PT, Hoffman TM (2014). "Pediatric heart transplantation-indications and outcomes in the current era". J Thorac Dis. 6 (8): 1080–96. doi:10.3978/j.issn.2072-1439.2014.06.16. PMC 4133537. PMID 25132975.