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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2017;70:371-81 - Vol. 70 Num.05 DOI: 10.1016/j.rec.2016.12.036

Heart Transplant and Mechanical Circulatory Support in Patients With Advanced Heart Failure

Cristina Sánchez-Enrique a, Ulrich P. Jorde b, José González-Costello a,

a Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Área de Malalties del Cor, Hospital Universitari de Bellvitge, Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
b Section for Heart Failure, Cardiac Transplantation and Mechanical Circulatory Support, Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, United States

Keywords

Advanced heart failure. Heart transplant. Mechanical circulatory support.

Abstract

Patients with advanced heart failure have a poor prognosis and heart transplant is still the best treatment option. However, the scarcity of donors, long waiting times, and an increasing number of unstable patients have favored the development of mechanical circulatory support. This review summarizes the indications for heart transplant, candidate evaluation, current immunosuppression strategies, the evaluation and treatment of rejection, infectious prophylaxis, and short and long-term outcomes. Regarding mechanical circulatory support, we distinguish between short- and long-term support and the distinct strategies that can be used: bridge to decision, recovery, candidacy, transplant, and destination therapy. We then discuss indications, risk assessment, management of complications, especially with long-term support, and outcomes. Finally, we discuss future challenges and how the widespread use of long-term support for patients with advanced heart failure will only be viable if their complications and costs are reduced.

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1885-5857/© 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved