Heart Transplant and Artificial Heart Systems
|Heart transplantation (HTX) and ventricular assist device [VAD] implantation are effective surgical treatment options for end-stage heart failure patients. However, among the many options for heart failure therapy (medications, implantable defibrillation systems, cardiac resynchronization therapy, alternative surgical measures), HTX and VAD implantation are usually used very late for various reasons.
Drug therapy for patients with heart failure has improved significantly in recent years. The introduction of cardiac resynchronization therapy has also contributed to clinical improvement in a proportion of patients. Newer surgical procedures (conventional cardiac surgery in high-risk patients, such as coronary and valve surgery, left ventricular reconstruction) have also been shown to be beneficial in appropriate patients (3).
In end-stage disease (NYHA III-IV), HTX is still the gold standard of therapy.
|VADs are an increasingly better treatment option not only as a bridge to transplantation, but also as a permanent implantation and as a “bridge to recovery”. Even for patients with so-called “fixed” pulmonary hypertension (>4 Wood units), VAD implantation can provide a decrease in pulmonary resistance within three to nine months (4). As a result, many heart failure centers are already implanting more VADs than performing HTX. However, it is unclear what “durable” means in years. The two patients who have survived the longest (>7.5 years) with a VAD worldwide (Jarvik 2000) are from centers in England (Oxford) and Germany (Freiburg).
However, quality of life is not the same after HTX and VAD, which is also pointed out by Strüber et al (2); psychological distress is higher after VAD implantation than after HTX. Overall, however, the surgical options have fortunately reached a standard today that allows successful therapy of many heart failure patients.
|Beyersdorf F||Dtsch Arztebl Int 2009; 106(28-29): 469-70; DOI: 10.3238/arztebl.2009.0469relating to:
The Current Status of Heart Transplantation and the Development of “Artificial Heart Systems”Dtsch Arztebl Int 2009; 106(28-29): 471-7; DOI: 10.3238/arztebl.2009.0471
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