(Circulation. 1995;92:3593-3612.)
© 1995 American Heart Association, Inc.
Articles |
Selection and Treatment of Candidates for Heart Transplantation
A Statement for Health Professionals From the Committee on Heart Failure and Cardiac Transplantation of the Council on Clinical Cardiology, American Heart Association
Improved outcome of heart failure in response to medical therapy, coupled with a critical shortage of donor organs, makes it imperative to restrict heart transplantation to patients who are most disabled by heart failure and who are likely to derive the maximum benefit from transplantation. Hemodynamic and functional indexes of prognosis are helpful in identifying these patients.
Stratification of ambulatory heart failure patients by objective criteria, such as peak exercise oxygen consumption, has improved ability to select appropriate adult patients for heart transplantation. Such patients will have a poor prognosis despite optimal medical therapy. When determining the impact of individual comorbid conditions on a patient's candidacy for heart transplantation, the detrimental effects of each condition on posttransplantation outcome should be weighed.
Evaluation of patients with severe heart failure should be done by a multidisciplinary team that is expert in management of heart failure, performance of cardiac surgery in patients with low left ventricular ejection fraction, and transplantation. Potential heart transplant candidates should be reevaluated on a regular basis to assess continued need for transplantation.
Long-term management of heart failure should include continuity of care by an experienced physician, optimal dosing in conventional therapy, and periodic reevaluation of left ventricular function and exercise capacity. The outcome of high-risk conventional cardiovascular surgery should be weighed against that of transplantation in patients with ischemic and valvular heart disease.
Establishment of regional specialized heart failure centers may improve access to optimal medical therapy and new promising medical and surgical treatments for these patients as well as stimulate investigative efforts to accelerate progress in this critical area.
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|
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|
|
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|
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|
|
|
|
|
|
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|
|
|
|
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|
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|
|
|
|
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|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
I. S. Anand, V. G. Florea, and L. Fisher Surrogate end points in heart failure J. Am. Coll. Cardiol., May 1, 2002; 39(9): 1414 - 1421. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.P. Siegenthaler, J. Martin, O.H. Frazier, and F. Beyersdorf Implantation of the permanent Jarvik-2000 left-ventricular-assist-device: surgical technique Eur. J. Cardiothorac. Surg., March 1, 2002; 21(3): 546 - 548. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. POPPAS and S. ROUNDS Congestive Heart Failure Am. J. Respir. Crit. Care Med., January 1, 2002; 165(1): 4 - 8. [Full Text] [PDF]
|
|
|
|
|
|
C. C. Canver and J. Chanda Heart transplantation Ann. Thorac. Surg., August 1, 2001; 72(2): 658 - 660. [Full Text] [PDF]
|
|
|
|
|
|
F. J. Meyer, M. M. Borst, C. Zugck, A. Kirschke, D. Schellberg, W. Kubler, and M. Haass Respiratory Muscle Dysfunction in Congestive Heart Failure : Clinical Correlation and Prognostic Significance Circulation, May 1, 2001; 103(17): 2153 - 2158. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Hansen, M. Haass, C. Zugck, C. Krueger, K. Unnebrink, R. Zimmermann, W. Kuebler, and H. Kuecherer Prognostic value of Doppler echocardiographic mitral inflow patterns: implications for risk stratification in patients with chronic congestive heart failure J. Am. Coll. Cardiol., March 15, 2001; 37(4): 1049 - 1055. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C Opasich, G.D Pinna, A Mazza, O Febo, R Riccardi, P.G Riccardi, S Capomolla, G Forni, F Cobelli, and L Tavazzi Six-minute walking performance in patients with moderate-to-severe heart failure; is it a useful indicator in clinical practice? Eur. Heart J., March 2, 2001; 22(6): 488 - 496. [Abstract] [PDF]
|
|
|
|
 |
|
 M. K. Giacomini, D. J. Cook, D. L. Streiner, and S. S. Anand Guidelines as rationing tools: a qualitative analysis of psychosocial patient selection criteria for cardiac procedures Can. Med. Assoc. J., March 1, 2001; 164(5): 634 - 640. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S W Dubrey, M M Burke, A Khaghani, P N Hawkins, M H Yacoub, and N R Banner Long term results of heart transplantation in patients with amyloid heart disease Heart, February 1, 2001; 85(2): 202 - 207. [Abstract] [Full Text]
|
|
|
|
|
|
R. C. Starling, P. M. McCarthy, T. Buda, J. Wong, M. Goormastic, N. G. Smedira, J. D. Thomas, E. H. Blackstone, and J. B. Young Results of partial left ventriculectomy for dilated cardiomyopathy: Hemodynamic, clinical and echocardiographic observations J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2098 - 2103. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. M. Givertz Underlying Causes and Survival in Patients with Heart Failure N. Engl. J. Med., April 13, 2000; 342(15): 1120 - 1122. [Full Text]
|
|
|
|
|
|
C Zugck, C Kruger, S Durr, S.H Gerber, A Haunstetter, K Hornig, W Kubler, and M Haass Is the 6-minute walk test a reliable substitute for peak oxygen uptake in patients with dilated cardiomyopathy? Eur. Heart J., April 1, 2000; 21(7): 540 - 549. [Abstract] [PDF]
|
|
|
|
|
|
D. Mancini, T. LeJemtel, and K. Aaronson Peak VO2 : A Simple yet Enduring Standard Circulation, March 14, 2000; 101(10): 1080 - 1082. [Full Text] [PDF]
|
|
|
|
 |
|
 D J Wright and L B Tan Classic techniques in medicine: The role of exercise testing in the evaluation and management of heart failure Postgrad. Med. J., August 1, 1999; 75(886): 453 - 458. [Abstract] [Full Text]
|
|
|
|
 |
|
 I. A Paraskevaidis, D. P Tsiapras, S. Adamopoulos, and D. T. Kremastinos Assessment of the functional status of heart failure in non ischemic dilated cardiomyopathy: an echo-dobutamine study Cardiovasc Res, July 1, 1999; 43(1): 58 - 66. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. W. Lee, J.-H. Lee, J.-J. Kim, S.-W. Park, M.-K. Hong, S.-T. Kim, T.-H. Lim, and S.-J. Park Cerebral metabolic abnormalities in congestive heart failure detected by proton magnetic resonance spectroscopy J. Am. Coll. Cardiol., April 1, 1999; 33(5): 1196 - 1202. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Metra, P. Faggiano, A. D'Aloia, S. Nodari, A. Gualeni, D. Raccagni, and L. Dei Cas Use of cardiopulmonary exercise testing with hemodynamic monitoring in the prognostic assessment of ambulatory patients with chronic heart failure J. Am. Coll. Cardiol., March 15, 1999; 33(4): 943 - 950. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Ramos-Barbon, D. Fitchett, W. J. Gibbons, D. A. Latter, and R. D. Levy Maximal Exercise Testing for the Selection of Heart Transplantation Candidates: Limitation of Peak Oxygen Consumption Chest, February 1, 1999; 115(2): 410 - 417. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D Czitrom, D Karila-Cohen, E Brochet, J M Juliard, M Faraggi, M-C Aumont, P Assayag, and P G Steg Acute assessment of microvascular perfusion patterns by myocardial contrast echocardiography during myocardial infarction: relation to timing and extent of functional recovery Heart, January 1, 1999; 81(1): 12 - 16. [Abstract] [Full Text]
|
|
|
|
|
|
S. Gradinac, M. Miric, Z. Popovic, A. D. Popovic, A. N. Neskovic, L. Jovovic, L. Vuk, and M. Bojic Partial left ventriculectomy for idiopathic dilated cardiomyopathy: early results and six-month follow-up Ann. Thorac. Surg., December 1, 1998; 66(6): 1963 - 1968. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. D. Trachiotis, W. S. Weintraub, T. S. Johnston, E. L. Jones, R. A. Guyton, and J. M. Craver Coronary artery bypass grafting in patients with advanced left ventricular dysfunction Ann. Thorac. Surg., November 1, 1998; 66(5): 1632 - 1639. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. Hunt and O.H. Frazier Mechanical Circulatory Support and Cardiac Transplantation Circulation, May 26, 1998; 97(20): 2079 - 2090. [Full Text] [PDF]
|
|
|
|
|
|
J. M. Chen, H. R. Levin, R. E. Michler, C. J. Prusmack, E. A. Rose, and K. D. Aaronson REEVALUATING THE SIGNIFICANCE OF PULMONARY HYPERTENSION BEFORE CARDIAC TRANSPLANTATION: DETERMINATION OF OPTIMAL THRESHOLDS AND QUANTIFICATION OF THE EFFECT OF REVERSIBILITY ON PERIOPERATIVE MORTALITY J. Thorac. Cardiovasc. Surg., October 1, 1997; 114(4): 627 - 634. [Abstract] [Full Text]
|
|
|
|
|
|
T. De Marco and L. Goldman Predicting Outcomes in Severe Heart Failure Circulation, June 17, 1997; 95(12): 2597 - 2599. [Full Text]
|
|
|
|
|
|
D. B. Chomsky, C. C. Lang, G. H. Rayos, Y. Shyr, T.-K. Yeoh, R. N. Pierson III, S. F. Davis, and J. R. Wilson Hemodynamic Exercise Testing: A Valuable Tool in the Selection of Cardiac Transplantation Candidates Circulation, December 15, 1996; 94(12): 3176 - 3183. [Abstract] [Full Text]
|
|
|
|
|
|
K. A. Catanese, D. J. Goldstein, D. L. Williams, A. T. Foray, C. D. Illick, M. T. Gardocki, A. D. Weinberg, H. R. Levin, E. A. Rose, and M. C. Oz Outpatient Left Ventricular Assist Device Support: A Destination Rather Than a Bridge Ann. Thorac. Surg., September 1, 1996; 62(3): 646 - 652. [Abstract] [Full Text]
|
|