End-stage heart disease and indications for heart transplantation

Abstract

Heart failure is a leading cause of morbidity and mortality in the United States and worldwide. Despite significant advances in the treatment of heart failure (both pharmacologic and electrical), many patients progress and/or are refractory to these interventions and warrant consideration for advanced therapies, including mechanical circulatory support and/or heart transplantation. The decisions on these approaches are complex and depend on both what is medically appropriate, the patient's values, and overall goals of care. In particular, due to limited organ availability and significant perioperative risk related to heart transplantation, patients require an extensive medical and psychosocial evaluation by a designated transplant team to stratify the overall risk and the urgency of heart transplantation. Once objective data confirms significant cardiac limitation warranting consideration of cardiac transplantation, evaluation includes ruling out non-cardiac organ dysfunction, other medical comorbidities that could negatively impact on 5-year survival, major immune incompatibility, and cognitive, psychosocial, or behavioral limitations to patient survival. All of these areas are critical to clinical success post-cardiac transplantation. This chapter discusses clinical manifestations and clinical course of heart failure and indications for and medical evaluation for heart transplantation.