Heart Transplantation: New Realities, Challenges and Developments - Surgical Perspectives

In recent years, the use of MCS devices in treating patients with end-stage heart disease has increased significantly, as a bridge to transplantation and as destination therapy for transplant ineligible candidates. This increase is based on the accumulated experience with new second-generation continuous-flow devices which show significant improvements in survival, functional capacity and quality of life [1,2] (Figure 1). On the basis of the Heart Mate II Registry experience (1300 patients); guidelines for the clinical management of patients treated with continuous-flow devices have been published [3]. Risk scoring systems, such as the Seattle Heart Failure Model [4] and the Cumulative Risk Score for 90-Day in-Hospital Mortality [5] and the Destination Therapy Risk Score have been investigated to stratify patients who might benefit from LVAD support [6].The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) registry, follows all long-term MCS systems in the United States shows I year survival for continuous flow LVAD IS 82.2%.