Heart transplantation indications: Difference between revisions
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{{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}} | ||
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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><ref>Mehra, MR, Kobashigawa, J, Starling, R, et al. Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates--2006. J Heart Lung Transplant 2006; 25:1024.</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>Mehra, MR, Kobashigawa, J, Starling, R, et al. Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates--2006. J Heart Lung Transplant 2006; 25:1024.</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=}}</ref><ref>Mehra, MR, Kobashigawa, J, Starling, R, et al. Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates--2006. J Heart Lung Transplant 2006; 25:1024.</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>Mehra, MR, Kobashigawa, J, Starling, R, et al. Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates--2006. J Heart Lung Transplant 2006; 25:1024.</ref>. | ||
===Systolic | ===Systolic Heart Failure with a Left Ventricular Ejection Fraction less than 35%=== | ||
Due to either: | *Due to either: | ||
:*Ischemic [[cardiomyopathy]] | :*Ischemic [[cardiomyopathy]] | ||
:*Dilated [[cardiomyopathy]] | :*Dilated [[cardiomyopathy]] | ||
| Line 12: | Line 14: | ||
:*''Etiologies which are excluded are [[amyloid]], [[HIV]], and cardiac [[sarcoma]]'' | :*''Etiologies which are excluded are [[amyloid]], [[HIV]], and cardiac [[sarcoma]]'' | ||
===Ischemic | ===Ischemic Coronary Artery Disease with Refractory Angina=== | ||
Ischemia which is not amenable to [[coronary artery bypass graft surgery]] (CABG) and is refractory to maximally tolerated medical therapy | *Ischemia which is not amenable to [[coronary artery bypass graft surgery]] (CABG) and is refractory to maximally tolerated medical therapy | ||
===Intractable life-threatening | |||
===Intractable life-threatening Arrhythmias=== | |||
*[[Ventricular arrhythmias]] which are not controlled by an [[implantable cardioverter-defibrillator]] | |||
*[[Ventricular arrhythmias]] that are refractory or not amenable to electrophysiologic guided single or combination medical therapy | |||
* Patients that are not a candidate for ablative therapy | |||
===Hypertrophic | ===Hypertrophic Obstructive Cardiomyopathy (HOCM)=== | ||
NYHA Class IV [[heart failure]] symptoms persist despite maximal medical therapy, [[myomectomy]], [[alcohol septal ablation]], [[mitral valve replacement]] | *[[New york heart association functional classification|NYHA Class IV]] [[heart failure]] symptoms persist despite maximal medical therapy, [[myomectomy]], [[alcohol septal ablation]], [[mitral valve replacement]] | ||
===Congenital | ===Congenital Heart Disease=== | ||
*Fixed [[pulmonary hypertension]] must not be present | |||
===Additional Considerations=== | ===Additional Considerations=== | ||
*The patient should have a stable psychosocial situation | |||
==References== | ==References== | ||
Revision as of 04:45, 8 April 2012
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Risk calculators and risk factors for Heart transplantation indications |
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][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 [3].
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 coronary artery bypass graft surgery (CABG) and is refractory to maximally tolerated medical therapy
Intractable life-threatening Arrhythmias
- Ventricular arrhythmias which are not controlled by an implantable cardioverter-defibrillator
- Ventricular arrhythmias that are refractory or not amenable to electrophysiologic guided single or combination medical therapy
- Patients that are not a candidate for ablative therapy
Hypertrophic Obstructive Cardiomyopathy (HOCM)
- NYHA Class IV heart failure symptoms persist despite maximal medical therapy, myomectomy, alcohol septal ablation, mitral valve replacement
Congenital Heart Disease
- Fixed pulmonary hypertension must not be present
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, Kobashigawa, J, Starling, R, et al. Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates--2006. J Heart Lung Transplant 2006; 25:1024.
- ↑ Mehra, MR, Kobashigawa, J, Starling, R, et al. Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates--2006. J Heart Lung Transplant 2006; 25:1024.