TY - CHAP M1 - Book, Section TI - Mechanical Circulatory Support and Heart Transplantation in Severe Heart Failure – Updated July 2023 A1 - DeVore, Adam D. A1 - Kittleson, Michelle M. A1 - Milano, Carmelo A. A1 - Patel, Jignesh K. A1 - Rogers, Joseph G. A1 - Kobashigawa, Jon A. A2 - Fuster, Valentin A2 - Narula, Jagat A2 - Vaishnava, Prashant A2 - Leon, Martin B. A2 - Callans, David J. A2 - Rumsfeld, John S. A2 - Poppas, Athena PY - 2022 T2 - Fuster and Hurst's The Heart, 15e AB - Chapter SummaryThis chapter explores the current status of mechanically assisted circulation and cardiac transplantation. Since the first successful heart transplant in 1967, refinements to candidate and donor selection and management, manipulating the immune system, and surveillance for acute and chronic complications have been associated with progressively improved outcomes. Contemporary median survival following heart transplant is 12.5 years, extending to 14.8 years in those surviving the first year after the procedure. Similarly, mechanically assisted circulation using left ventricular assist devices (LVADs) has become a standard of care for patients failing medical therapies awaiting transplantation or in those ineligible for transplant (see Fuster and Hurst’s Central Illustration). Newer devices are small, continuous flow pumps with enhanced hemocompatibility to minimize bleeding and thrombosis complications. The mean survival after LVAD implantation is nearly 5 years. Patient selection approaches for mechanical and biologic replacement, as well as the roles for palliative care and shared decision-making in supporting the patients with advanced heart failure and their families, are discussed. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/11/06 UR - accesscardiology.mhmedical.com/content.aspx?aid=1202455647 ER -