Current Heart Failure Reports

, Volume 6, Issue 1, pp 28–33 | Cite as

Current status of cardiac transplantation and mechanical circulatory support



Cardiac transplantation and mechanical circulatory support are possible options for improving survival and quality of life in patients with isolated cardiac disease and end-stage heart failure. Transplantation is limited by donor availability but has a median survival of 10 years. Post-transplant immunosuppression is often transplant center dependent, but a tacrolimus and mycophenolate mofetil-based regimen may be preferred. Sirolimus may reduce the progression rate of transplant vasculopathy. There has been a trend toward continuous-flow left ventricular assist devices because of their increased durability and reduced size. A variety of surgical and percutaneous ventricular assist devices may be used as a bridge to decision on a patient’s candidacy for transplantation. Mechanical circulatory support as destination therapy has not been widely implemented because of poor device durability, but this is expected to change with newer devices. Mechanical circulatory support as a bridge to myocardial recovery has been successful only in a few patients.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Bolling SF, Pagani FD, Deeb GM, Bach DS: Intermediateterm outcome of mitral reconstruction in cardiomyopathy. J Thorac Cardiovasc Surg 1998, 115:381–386.PubMedCrossRefGoogle Scholar
  2. 2.
    Wu AH, Aaronson KD, Bolling SF, et al.: Impact of mitral valve annuloplasty on mortality risk in patients with mitral regurgitation and left ventricular systolic dysfunction. J Am Coll Cardiol 2005, 45:381–387.PubMedCrossRefGoogle Scholar
  3. 3.
    Mancini DM, Eisen H, Kussmaul W, et al.: Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation 1991, 83:778–786.PubMedGoogle Scholar
  4. 4.
    Hershberger RE, Nauman D, Walker TL, et al.: Care processes and clinical outcomes of continuous outpatient support with inotropes (COSI) in patients with refractory endstage heart failure. J Card Fail 2003, 9:180–187.PubMedCrossRefGoogle Scholar
  5. 5.
    Hershberger RE, Starling RC, Eisen HJ, et al.: Daclizumab to prevent rejection after cardiac transplantation. N Engl J Med 2005, 352:2705–2713.PubMedCrossRefGoogle Scholar
  6. 6.
    Mehra MR, Zucker MJ, Wagoner L, et al.: A multicenter, prospective, randomized, double-blind trial of basiliximab in heart transplantation. J Heart Lung Transplant 2005, 24:1297–1304.PubMedCrossRefGoogle Scholar
  7. 7.
    Taylor DO, Edwards LB, Aurora P, et al.: Registry of the International Society for Heart and Lung Transplantation: twenty-fifth official adult heart transplant report-2008. J Heart Lung Transplant 2008, 27:943–956.PubMedCrossRefGoogle Scholar
  8. 8.
    Eisen HJ, Kobashigawa J, Keogh A, et al.: Three-year results of a randomized, double-blind, controlled trial of mycophenolate mofetil versus azathioprine in cardiac transplant recipients. J Heart Lung Transplant 2005, 24:517–525.PubMedCrossRefGoogle Scholar
  9. 9.
    Mancini D, Pinney S, Burkhoff D, et al.: Use of rapamycin slows progression of cardiac transplantation vasculopathy. Circulation 2003, 108:48–53.PubMedCrossRefGoogle Scholar
  10. 10.
    Kobashigawa JA, Miller LW, Russell SD, et al.: Tacrolimus with mycophenolate mofetil (MMF) or sirolimus vs. cyclosporine with MMF in cardiac transplant patients: 1-year report. Am J Transplant 2006, 6:1377–1386.PubMedCrossRefGoogle Scholar
  11. 11.
    Chen JM, Russo MJ, Hammond KM, et al.: Alternate waiting list strategies for heart transplantation maximize donor organ utilization. Ann Thorac Surg 2005, 80:224–228.PubMedCrossRefGoogle Scholar
  12. 12.
    Kobashigawa JA, Moriguchi JD, Laks H, et al.: Ten-year follow-up of a randomized trial of pravastatin in heart transplant patients. J Heart Lung Transplant 2005, 24:1736–1740.PubMedCrossRefGoogle Scholar
  13. 13.
    Tanaka K, Li H, Curran PJ, et al.: Usefulness and safety of percutaneous coronary interventions for cardiac transplant vasculopathy. Am J Cardiol 2006, 97:1192–1197.PubMedCrossRefGoogle Scholar
  14. 14.
    Frazier OH, Rose EA, Oz MC, et al.: Multicenter clinical evaluation of the HeartMate vented electric left ventricular assist system in patients awaiting heart transplantation. J Thorac Cardiovasc Surg 2001, 122:1186–1195.PubMedCrossRefGoogle Scholar
  15. 15.
    El-Banayosy A, Deng M, Loisance DY, et al.: The European experience of Novacor left ventricular assist (LVAS) therapy as a bridge to transplant: a retrospective multi-centre study. Eur J Cardiothorac Surg 1999, 15:835–841.PubMedCrossRefGoogle Scholar
  16. 16.
    Aaronson KD, Eppinger MJ, Dyke DB, et al.: Left ventricular assist device therapy improves utilization of donor hearts. J Am Coll Cardiol 2002, 39:1247–1254.PubMedCrossRefGoogle Scholar
  17. 17.
    Pagani FD, Long JW, Dembitsky WP, et al.: Improved mechanical reliability of the HeartMate XVE left ventricular assist system. Ann Thorac Surg 2006, 82:1413–1418.PubMedCrossRefGoogle Scholar
  18. 18.
    Miller LW, Pagani FD, Russell SD, et al.: Use of a continuous- flow device in patients awaiting heart transplantation. N Engl J Med 2007, 357:885–896.PubMedCrossRefGoogle Scholar
  19. 19.
    Russell SD, Dyke DB, Aranda JM, et al.: Renal and hepatic function improve in advanced heart failure patients during continuous flow support with the HeartMate II LVAD [abstract 144]. Presented at the 11th Annual Scientific Meeting of the Heart Failure Society of America. Washington DC; September 16–19, 2007.Google Scholar
  20. 20.
    Boyle AJ, Griffith B, Ascheim D, et al.: The VentrAssist LVAD as a bridge to cardiac transplantation: results on the US feasibility trial [abstract 518]. Presented at the International Society of Heart and Lung Transplantation 28th Annual Meeting and Scientific Sessions. Boston, MA; April 9–12, 2008.Google Scholar
  21. 21.
    Kirklin JK, Naftel DC, Stevenson LW, et al.: INTERMACS database for durable devices for circulatory support: first annual report. J Heart Lung Transplant 2008, 27:1065–1072.PubMedCrossRefGoogle Scholar
  22. 22.
    Lietz K, Long JW, Kfoury AG, et al.: Outcomes of left ventricular assist device implantation as destination therapy in the post-REMATCH era. Circulation 2007, 116:497–505.PubMedCrossRefGoogle Scholar
  23. 23.
    Boyle AJ, Teuteberg JJ, Ascheim D, et al.: LVADs for less acutely ill patients: do current data justify the strategy? Presented at the 54th American Society of Artificial Internal Organs Annual Conference. San Francisco, CA; June 19–21, 2008.Google Scholar
  24. 24.
    John R, Liao K, Lietz K, et al.: Experience with the Levitronix CentriMag circulatory support system as a bridge to decision in patients with refractory acute cardiogenic shock and multisystem organ failure. J Thorac Cardiovasc Surg 2007, 134:351–358.PubMedCrossRefGoogle Scholar
  25. 25.
    Burkhoff D, Cohen H, Brunckhorst C, et al.: A randomized multicenter clinical study to evaluate the safety and efficacy of the TandemHeart percutaneous ventricular assist device versus conventional therapy with intraaortic balloon pumping for treatment of cardiogenic shock. Am Heart J 2006, 152:469.e1–469.e8.CrossRefGoogle Scholar
  26. 26.
    Henriques JP, Remmelink M, Baan J Jr, et al.: Safety and feasibility of elective high-risk percutaneous coronary intervention procedures with left ventricular support of the Impella Recover LP 2.5. Am J Cardiol 2006, 97:990–992.PubMedCrossRefGoogle Scholar
  27. 27.
    Greenberg B, Czerska B, Delgado RM, et al.: Effects of continuous aortic flow augmentation in patients with exacerbation of heart failure inadequately responsive to medical therapy: results of the Multicenter Trial of the Orqis Medical Cancion System for the Enhanced Treatment of Heart Failure Unresponsive to Medical Therapy (MOMENTUM). Circulation 2008, 118:1241–1249.PubMedCrossRefGoogle Scholar
  28. 28.
    Rose EA, Gelijns AC, Moskowitz AJ, et al.: Long-term mechanical left ventricular assistance for end-stage heart failure. N Engl J Med 2001, 345:1435–1443.PubMedCrossRefGoogle Scholar
  29. 29.
    Simon MA, Kormos RL, Murali S, et al.: Myocardial recovery using ventricular assist devices: prevalence, clinical characteristics, and outcomes. Circulation 2005, 112(9 Suppl):I32–I36.PubMedGoogle Scholar
  30. 30.
    Birks EJ, Tansley PD, Hardy J, et al.: Left ventricular assist device and drug therapy for the reversal of heart failure. N Engl J Med 2006, 355:1873–1884.PubMedCrossRefGoogle Scholar
  31. 31.
    Maybaum S, Mancini D, Xydas S, et al.: Cardiac improvement during mechanical circulatory support: a prospective multicenter study of the LVAD working group. Circulation 2007, 115:2497–2505.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group, LLC 2009

Authors and Affiliations

  1. 1.University of MinnesotaMinneapolisUSA

Personalised recommendations