Evoluzione delle indicazioni al trapianto cardiaco e all'impianto di dispositivi di assistenza ventricolare sinistra

Translated title of the contribution: Evolution of the indications for heart transplant and left ventricular assist device implant

Enrico Ammirati, Fabrizio Oliva, Tiziano Colombo, Luca Botta, Manlio Cipriani, Aldo Cannata, Alessandr Verde, Fabio M. Turazza, Claudio F. Russo, Roberto Paino, Luigi Martinelli, Maria Frigerio

Research output: Contribution to journalArticle

Abstract

Heart transplantation (HTx) is considered to be the gold standard treatment for advanced heart failure (HF) but it is available only for a minority of patients, due to paucity of donor hearts (278 HTx were performed in 2011 in Italy). Patients listed for HTx have a prolonged waiting time (that is about 2.3 years in the 2006-2010 time period in Italy) that is superior compared with patients who receive HTx (median time around 6 months), to underline the presence of an allocation system that prioritizes candidates in critical conditions. Patients listed for HTx have a poor quality of life and their annual mortality is around 8-10%. Another 10-15% of HTx candidates are removed from the waiting list each year because they are no longer suitable for transplantation. On the other hand, continuous-flow left ventricular assist devices (LVADs) have been demonstrated to improve survival and quality of life of patients with advanced/refractory HF. LVAD therapy can represent a valid alternative to HTx, and it is recommended for patients with advanced HF in the recent edition of the European Society of Cardiology guidelines on HF management. In the United States, a larger number of centers compared with European ones started to apply a strategy of LVAD implant for many patients who meet clinical criteria for listing for HTx. Data from our center concerning the last 6 years of LVAD implant (51 implants since 2006) reported a 75.5% survival rate at 1 year. In Italian series, as in our center, current HTx survival is only slightly superior (83% survival rate at 1 year), based on data from the Italian National Transplant Center. We report a proposal for updated listing criteria for HTx and indications for LVAD implant in patients with advanced acute and chronic HF. Criteria for identifying suitable patients for HTx and/or LVAD considering the shortage of donors are discussed.

Translated title of the contributionEvolution of the indications for heart transplant and left ventricular assist device implant
Original languageItalian
Pages (from-to)110-119
Number of pages10
JournalGiornale Italiano di Cardiologia
Volume14
Issue number2
DOIs
Publication statusPublished - Feb 2013

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Ammirati, E., Oliva, F., Colombo, T., Botta, L., Cipriani, M., Cannata, A., Verde, A., Turazza, F. M., Russo, C. F., Paino, R., Martinelli, L., & Frigerio, M. (2013). Evoluzione delle indicazioni al trapianto cardiaco e all'impianto di dispositivi di assistenza ventricolare sinistra. Giornale Italiano di Cardiologia, 14(2), 110-119. https://doi.org/10.1714/1218.13523