Heart Transplantation for Cardiomyopathy - therapeutic Gold Standard?

Abstract

The number of heart transplantations steadily increased worldwide during the 1980s and has plateaued since 1990 around 3500-4000 annually performed procedures. Meanwhile, more than 48000 such interventions have been reported during the last 20 years [7]. Improved immunosuppression, antibiotic, and antimycotic therapies have led to better survival and longterm results even in patients with multiple concomitant diseases. Thus, cardiac transplantation has evolved from an experimental procedure to the therapeutic gold standard for patients with end-stage heart failure, refractory to medical treatment. Limitations of this procedure are evident with lack of available donor organs, side effects of immunosuppression (e.g., hypertension, renal insufficiency, osteoporosis) as well as an increased malignancy rate and chronic allograft rejection being the most predominant. Alternatively, new organ preserving surgical strategies as well as mechanical cardiac support devices have evolved, aiming at improvements in patient symptoms and quality of life as well as survival. Evaluation of all these techniques has to be balanced carefully against the results achieved with heart transplantation during the last two decades. The aim of this article is to present our management combined with long-term results in this patient group.