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== | ||
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 | 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. | ||
According to the The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation, the main indications for heart transplant are the following- <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> | |||
===Systolic Heart Failure with a Left Ventricular Ejection Fraction less than 35%=== | |||
*Due to either: | *Due to either: | ||
Revision as of 18:48, 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
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.
According to the The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation, the main indications for heart transplant are the following- [2]
Systolic Heart Failure with a Left Ventricular Ejection Fraction less than 35%
- 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
- ↑ 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) - ↑ 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.