Heart failure CARDIAC TRANSPLANTATION

As a consequence of improved management in acute coronary syndromes and improved longevity of the population, the number of patients with heart failure is growing. The prevalence and incidence in industrialised countries are estimated to be around 1% and 0.15% of the population, respectively. Up to 10% of people with heart failure are at an advanced stage, amounting to 300 000 patients in the USA and 60 000 in the UK. In parallel, research w2–5 has led to the concept of cardiac replacement by transplantation. Following the first successful heart transplantation in 1967 in the Groote-Schuur-Hospital, Kapstadt, South Africa, the first successful US heart transplant was performed in 1968 at Stanford University. In the same year, an ad hoc committee at Harvard University established the criteria of brain death. More than 55 000 cardiac transplants have now been performed in more than 200 hospitals worldwide (www.ishlt.org). The combination of good surgical success rates and the presence of a growing number of well equipped cardiac transplant programmes has created an enormous flux of heart failure patients towards these centres. Since the annual cardiac transplantation rate will likely remain below 4500 worldwide, with < 3000 in the USA and < 300 in the UK, it is evident that cardiac transplantation will continue to play only a very limited quantitative role in the treatment of the advanced heart failure syndrome. Yet, its importance will continue to reside with its role as the option of last resort for patients with advanced heart failure, offered within centres with a complete spectrum of medical and surgical treatment options. The aim of this review is to outline a contemporary perspective on cardiac transplantation with respect to recipient and donor management, as well as an appropriate organisational policy. For further background reading, excellent material is available.