Abstract
The likelihood that the incidence of advanced heart failure will significantly diminish in the future is not high. Over the past 50 years human heart transplantation has been performed in tens of thousands with end-stage heart failure to forestall misery and premature death. But will that operation still be done in a decade? Tremendous, but still insufficient, insight into heart transplant patient selection and management has accrued. Reasonable short and longer term survival is now seen with the postoperative half-life of recipients in the range of 12 years. However, significant comorbidities occur with substantial frequency, including hypertension, diabetes, hyperlipidemia, renal dysfunction, and allograft vasculopathy. Unfortunately an inadequate number of available donor hearts is a gruesome governor. Over roughly the same period of time, mechanical circulatory assist and replacement devices evolved as a bridge-to-transplant or “destination” therapy (meaning the device would be left in place for a lifetime). A hope has been that these machines would ameliorate the donor organ shortage while improving clinical outcomes compared to heart transplantation by offering an off-the-shelf alternative that had comparable, at the least, outcomes. Will these pumps, or even the much hyped cell transplant procedures, replace the need for heart transplant?
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References
Allen LA, Stevenson LW, Grady KL et al (2012) Decision making in advanced heart failure. A statement from the American Heart Association. Circulation 125:1928–1952
Barnard CN (1967) The operation – a human cardiac transplant: an interim report of a successful operation performed at Groote Schuur Hospital, Cape Town. S Afr Med J 41:1271–1274
Barnard CN, Pepper CB (1969) One life. McMillan Company, New York
Bently TS, Hanson SG (2014) 2014 US organ and tissue transplant cost estimates and discussion. Milliman Research Report. December, 2014
Frazier OH, Kirklin JK (2006) Mechanical circulatory support, ISHLT monograph series, vol 1. Elsevier, Philadelphia
Jakovljevic DG, Yacoub MH, Schueler S et al (2017) Left ventricular assist device as a bridge to recovery for patients with advanced heart failure. J Am Coll Cardiol 69:1924–1933
Kirklin JK, Young JB, McGiffin DC (2002) Heart transplantation. Churchill Livingstone, Philadelphia
Kirklin JK, Mehra M, West LJ (2010) History of international heart and lung transplantation, ISHLT monograph series, vol 4. Elsevier, Philadelphia
Kirklin JK, Naftel DC, Pagani FD et al (2012) Long-term mechanical circulatory support (destination therapy): on track to compete with heart transplantation? J Thorac Cardiovasc Surg 144:586–603
Kirklin JK, Naftel DC, Pagani FD et al (2015) Seventh INTERMACS annual report: 15,000 patients and counting. J Heart Lung Transplant 34:1495–1504
Lund LH, Edwards LB, Dipchand AI et al (2016) The registry of the International Society for Heart and Lung Transplantation: thirty-third adult heart transplantation report – 2016 focus: diagnostic indications for transplant. J Heart Lung Transplant 35:1158–1169
McRae D (2006) Every second counts: the race to transplant the first human heart. Putnam Press – Penguin Group, London
Mehra MR, Goldstein DJ, Uriel N et al (2018) Two-year outcomes with a magnetically levitated cardiac pump in heart failure. N Engl J Med 378:1386–1395
Miller LW, Guglin M, Rogers J (2012) Cost of ventricular assist devices. Can we afford the progress? Circulation 127:743–748
Moskowitz AJ, Rose EA, Gelijns AC (2001) The cost of long term LVAD implantation. Ann Thorac Surg 71:s195–s198
Paganini FD, Aaronson KD, Kormos R et al (2016) The NHLBI REVIVE-IT study: understanding its discontinuation in the context of current left ventricular assist device therapy. J Heart Lung Transplant 35:1277–1283
Pinney SP, Anyanwu AC, Lala A, Teuteberg JJ, Uriel N, Mehra MR (2017) Left ventricular assist devices for lifelong support. J Am Coll Cardiol 69:2845–2861
Schumer EM, Black MC, Monreal G, Slaughter MS (2016) Left Ventricular assist devices: current controversies and future directions. Eur Heart J 37:3434–3439
Starzl TE (1992) The puzzle people: memoirs of a transplant surgeon. University of Pittsburgh Press, Pittsburgh
Stehlik J, Mehra M, Sweet SC et al (2015) The International Society for Heart and Lung Transplantation Registries in the era of big data with global reach. J Heart Lung Transplant 34:1225–1232
Stevenson LW, Kormos RL, Young JB, Kirklin JK, Hunt SA (2016) Major advantages and critical challenge for the proposed United States heart allocation system. J Heart Lung Transplant 35:547–549
Tilney NL (2003) Transplant: from myth to reality. Yale University Press, New Haven
Udelson JE, Stevenson LW (2016) The future of heart failure diagnosis, therapy and management. Circulation 133:261–2686
Vrtovec B, Poglajen G, Haddad F (2013) Stem cell therapy in patients with heart failure. Methodist Debakey Cardiovasc J 9:6–10
Winters WL Jr, Parish B (2014) Houston hearts: a history of cardiovascular surgery and medicine and the Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital. Elisha Freeman Publishing, Houston
Winters WL Jr, Parish B (2016) Reflections – Houston Methodist Hospital: a supplement to Houston hearts. Elisha Freeman Publishing, Houston
Yancy CW, Jessup M, Bozkurt B et al (2017) 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure. Circulation 135:e1–e75
Young JB, Baumgartner WA, Reitz B, Ohler L (2010) Magic moments in heart transplant. In: Kirklin JK, Mehra M, West LJ (eds) ISHLT monograph series, history of international heart and lung transplantation, vol 4. Elsevier, Philadelphia, pp 45–90
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Young, J.B. (2019). Will We Still Be Doing Heart Transplants in 10 Years?. In: Bogar, L., Mountis, M. (eds) Contemporary Heart Transplantation. Organ and Tissue Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-33280-2_42-1
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DOI: https://doi.org/10.1007/978-3-319-33280-2_42-1
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