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Heart Transplantation
Introduction
Heart transplantation is an option for patients who have any of the following and who remain at risk of death and have intolerable symptoms despite optimal use of drugs and medical devices: End-stage Heart Failure (HF) None Overview of Coronary Artery Disease None Overview of Arrhythmias None Hypertrophic Cardiomyopathy None Overview of Congenital Cardiovascular Anomalies None Transplantation may also be indicated for patients who Cannot be weaned from temporary cardiac-assist devices after myocardial infarction or nontransplant cardiac surgery Have cardiac sequelae of a lung disorder requiring lung transplantation Theonly absolute contraindicationfor heart transplantation is Pulmonary Hypertension that does not respond to preoperative treatments Relative contraindicationsinclude organ insufficiency (eg, pulmonary, renal, hepatic) and local or systemic infiltrative disorders (eg, cardiac sarcoma, amyloidosis). Recipient contraindications to transplantation should also be considered. All donated hearts come from brain-dead donors, who are usually required to be<60 years and have normal cardiac and pulmonary function and no history of coronary artery disease or other heart disorders. Donor and recipient must have compatible ABO blood type and heart size. About 25% of eligible recipients die before a donor organ becomes available. Left ventricular assist devices and artificial hearts provide interim hemodynamic support for patients waiting for a transplant. However, these devices carry a risk of sepsis, device failure, and thromboembolism. (See also Overview of Transplantation .) 