Heart transplantation indications: Difference between revisions
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'''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}} | ||
==Indications== | ==Indications== <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> | ||
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=}} | 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 | ||
===Systolic Heart Failure with a Left Ventricular Ejection Fraction less than 35%=== <ref name="MontoyaGiraldo2001">{{cite journal|last1=Montoya|first1=Jose G.|last2=Giraldo|first2=Luis F.|last3=Efron|first3=Bradley|last4=Stinson|first4=Edward B.|last5=Gamberg|first5=Pat|last6=Hunt|first6=Sharon|last7=Giannetti|first7=Nadia|last8=Miller|first8=Joan|last9=Remington|first9=Jack S.|title=Infectious Complications among 620 Consecutive Heart Transplant Patients at Stanford University Medical Center|journal=Clinical Infectious Diseases|volume=33|issue=5|year=2001|pages=629–640|issn=1058-4838|doi=10.1086/322733}}</ref> | |||
*Due to either: | *Due to either: | ||
:*Ischemic [[cardiomyopathy]] | :*Ischemic [[cardiomyopathy]] | ||
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===Ischemic Coronary Artery Disease with Refractory Angina=== | ===Ischemic Coronary Artery Disease with Refractory Angina=== | ||
*Ischemia which is not amenable to [[coronary artery bypass graft surgery]] | *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 | ||
===Intractable life-threatening Arrhythmias=== | ===Intractable life-threatening Arrhythmias=== | ||
*[[Ventricular arrhythmias]] which are not controlled by an [[implantable cardioverter-defibrillator]] | *[[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 | |||
=== | ===Cardiomyopathies=== | ||
*[[New york heart association functional classification|NYHA Class IV]] [[heart failure]] symptoms persist despite maximal medical therapy, [[myomectomy]], [[alcohol septal ablation]], [[mitral valve replacement]] | *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 | |||
===Congenital Heart Disease=== | ===Congenital Heart Disease=== | ||
* | * 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) | |||
===Additional Considerations=== | ===Additional Considerations=== | ||
Revision as of 18:46, 6 June 2020
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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]
==Indications== [1] 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.[2] 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
===Systolic Heart Failure with a Left Ventricular Ejection Fraction less than 35%=== [3]
- 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
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
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
Congenital Heart Disease
- 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)
Additional Considerations
- The patient should have a stable psychosocial situation
References
- ↑ 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.
- ↑ 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) - ↑ Montoya, Jose G.; Giraldo, Luis F.; Efron, Bradley; Stinson, Edward B.; Gamberg, Pat; Hunt, Sharon; Giannetti, Nadia; Miller, Joan; Remington, Jack S. (2001). "Infectious Complications among 620 Consecutive Heart Transplant Patients at Stanford University Medical Center". Clinical Infectious Diseases. 33 (5): 629–640. doi:10.1086/322733. ISSN 1058-4838.