Heart transplantation indications

Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D.; Associate Editor-In-Chief:

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. 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.

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