Chapter

Cardiac transplantation and mechanical circulatory support

Jayan Parameshwar

in Oxford Textbook of Medicine

Fifth edition

Published on behalf of Oxford University Press

Published in print May 2010 | ISBN: 9780199204854
Published online May 2011 | e-ISBN: 9780199570973 | DOI: http://dx.doi.org/10.1093/med/9780199204854.003.160502_update_001

Series: Oxford Textbooks

Cardiac transplantation and mechanical circulatory support

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Cardiac transplantation

Cardiac transplantation is the treatment of choice for selected patients with advanced heart failure: median survival exceeds 10 years and recipients enjoy an excellent quality of life, but availability is severely limited by shortage of donor organs. The need for life-long immunosuppression is associated with side effects, including an increased incidence of malignancy. Newer immunosuppressive agents offer promise in reducing nephrotoxicity of conventional regimens and in delaying the onset of (currently inevitable) cardiac allograft vasculopathy.

Mechanical circulatory support

Ventricular assist devices (VADs) are mechanical blood pumps that work in parallel or series with the native ventricle: there are two main types—pulsatile, also referred to as volume displacement, and rotary. Significant complications arise from bleeding, thromboembolism, and infection.

Short-term use—several devices are available for use in patients who need support for days to periods of up to 4 to 6 weeks: these are invaluable in postcardiotomy cardiogenic shock and in patients who present in extremis with multiorgan failure.

Longer-term use—implantation of a device in patients with chronic heart failure must be viewed either as a bridge to heart transplantation or as permanent support. The REMATCH study (Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure) randomized patients with endstage heart failure to best medical therapy or the implantation of the HeartMate I assist device: survival was improved in the device group (52% vs 25% at 1 year; 23% vs 8% at 2 years).

Chapter.  4234 words.  Illustrated.

Subjects: Cardiovascular Medicine

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