Heart transplantation

Heart transplantation includes the removal of a patient’s heart and surgical implantation of a donor heart. Heart transplantation is considered only in end-stage heart failure when other therapies fail as a last resort. Patients with refractory heart failure should be referred to a heart failure program experienced in cardiac transplantation, especially if the VO2 max is < 10 mL/kg on cardiopulmonary stress testing.

Heart transplantation can improve survival in carefully selected individuals. The surgical process itself has an approximate 5% mortality rate. Afterwards, immunosuppressant drugs must be utilized including prednisone, cyclosporine and tacrolimus in order to prevent rejection.

Heart transplantation is not safe when severe fixed pulmonary hypertension, malignancy, any significant illness with limited survival, and any illness that would have a high likelihood of occurring in the transplanted heart. APatients over the age of 70 can still be considered, however most institutions use this age as a relative contraindication.

With heart transplantation, survival is steadily improving. Most patients now live at least 10 years after transplantation with the highest mortality rate being within the first 6 months of transplantation.

The ranking system to determine eligibility for transplantation is below:

Status IA: The patients in critical condition. Must be hospitalized and requiring mechanical or pharmacological support to sustain life (intraaortic balloon counterpulsation, left ventricular assist device, high doses of intravenous inotropic therapy). New York Heart Association functional class IV.

Status 1B: Less critically ill, but still seriously functionally impaired. These patients may have outpatient daily inotrope infusion. New York Heart Association functional class III or IV.

Status 2: The least urgent patients. These patients rarely receive transplantation since organs are in short supply and given to status 1A or status 1B patients first. New York Heart Association functional class II or III.