Heart transplantation overview

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

Overview
Heart transplantation or cardiac transplantation, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease to prolong life. The most common procedure is to take a working heart from a recently deceased organ donor (allograft) and implant it into the patient. The patient's own heart may either be removed (orthotopic procedure) or, less commonly, left in to support the donor heart (heterotopic procedure). It is also possible to take a heart from another species (xenograft), or implant a man-made artificial one, although the outcome of these two procedures has been less successful in comparison to the far more commonly performed allografts.

Cardiac transplantation is reserved for patients with end-stage congestive heart failure despite all interventions. 1 year survival is 80%, and 5 year survival is 60%. Lifelong immunosuppressive therapy is used to prevent (or postpone) rejection, but increases the risk for opportunistic infections and malignancies.

The indications for heart transplantation include severe hemodynamic compromise due to heart failure which equires IV inotropic support to maintain adequate organ perfusion; a peak Vo2 <10 ml/kg/min; NYHA Class IV symptoms not amenable to any other intervention; or recurrence of symptomatic ventricular arrhythmias refractory to all therapeutic intervention.