RT Book, Section
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
A2 Poppas, Athena
SR Print(0)
ID 1202455647
T1 Mechanical Circulatory Support and Heart Transplantation in Severe Heart Failure – Updated July 2023
T2 Fuster and Hurst's The Heart, 15e
YR 2022
FD 2022
PB McGraw-Hill Education
PP New York, NY
SN 9781264257560
LK accesscardiology.mhmedical.com/content.aspx?aid=1202455647
RD 2023/09/21
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.