Selection and Management of the Potential Candidate for Cardiac Transplantation

  • L. W. Stevenson


The potential benefits of transplantation were already recognized in 1968, as reflected in the statement from the Bethesda conference chaired by Francis Moore[1]: ‘Cardiac transplantation, still in an early stage of development, shows promise for the future treatment of many people with severe heart disease.’ At that time there were 20 survivors of 50 heart transplant procedures. Since then, cardiac transplantation has evolved from an experimental to an accepted clinical procedure, endorsed by Medicare in 1986 as ‘best therapy’ for end-stage heart failure. The current survival rate is 80-85% at I year and 60-70% at 5 years[2]. There have been over 30 000 heart transplants performed in the world, involving over 250 heart transplant centers.


Heart Failure Left Ventricular Ejection Fraction Heart Transplantation Pulmonary Capillary Wedge Pressure Cardiac Transplantation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Moore FD (Chairman). Fifth Bethesda Conference Report: Cardiac and other organ transplantation. Am J Cardiol. 1968;22:896.CrossRefGoogle Scholar
  2. 2.
    Hosenpud JD, Novick RJ, Breen TJ, Daily OP. The Registry of the International Society for Heart and Lung Transplantation: Eleventh official report, 1994. J Heart Lung Transplant. 1994;13:561.PubMedGoogle Scholar
  3. 3.
    Bach DS, Bolling SF. Early improvement in congestive heart failure after correction of secondary mitral regurgitation in end-stage cardiomyopathy. Am Heart J. 1995;129:1165.PubMedCrossRefGoogle Scholar
  4. 4.
    Louie HW, Laks H, Milgalter E et al. Ischemic cardiomyopathy: criteria for coronary revascularization and cardiac transplantation. Circulation. 1991(Suppl. III):290.Google Scholar
  5. 5.
    Elefteriades JA, Tolis G, Levi E, Mills LK, Zaret BL. Coronary artery bypass grafting in severe left ventricular dysfunction: excellent survival with improved ejection fraction and functional state. J Am Coll Cardiol. 1993;22:1411.PubMedGoogle Scholar
  6. 6.
    Cohn JN, Johnson G, Zicsche S et al. A comparison of enalapril with hydralazineisosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med. 1991;325:303.PubMedGoogle Scholar
  7. 7.
    The SOLVD Investigators: effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med. 1992;327:685.Google Scholar
  8. 8.
    Fonarow GC, Chelimsky-Fallick C. Stevenson LW et al. Effect of direct vasodilation with hydralazine versus angiotensin-converting enzyme inhibition with captopril on mortality in advanced heart failure: the Hy-C trial. J Am Coll Cardiol. 1992;19:842.PubMedGoogle Scholar
  9. 9.
    Miller LW, Kubo SH, Young JB et al. Report of the consensus conference on candidate selection for cardiac transplantation. J Heart Lung Transplant. 1995;14:562.PubMedGoogle Scholar
  10. 10.
    Votapka TV, Pennington DG. Circulatory assist devices in congestive heart failure. Cardiol Clin. 1994;12:143.PubMedGoogle Scholar
  11. 11.
    Frazier OH, Rose EA, Macmanus Q et al. Multicenter clinical evaluation of the HeartMate 1000IP left ventricular assist device. Ann Thorac Surg. 1992;53:1080.PubMedGoogle Scholar
  12. 12.
    Steimle AE, Stevenson LW, Fonarow GC, Hamilton MA, Moriguchi JD. Prediction of improvement in recent onset cardiomyopathy after referral for heart transplantation. J Am Coll Cardiol. 1994;23:553.PubMedGoogle Scholar
  13. 13.
    Semigran MJ, Thaik CM, Fifer MA et al. Exercise capacity and systolic and diastolic ventricular function after recovery from acute dilated cardiomyopathy. J Am Coll Cardiol. 1994;24:462.PubMedGoogle Scholar
  14. 14.
    O’Connell JB, Constanzo-Nordin MR, Subramanian R et al. Peripartum cardiomyopathy: clinical, hemodynamic, histologic, and prognostic characteristics. J Am Coll Cardiol. 1986;8:52.PubMedGoogle Scholar
  15. 15.
    Regan TJ. Alcohol and the cardiovascular system: a review. J Am Med Assoc. 1991;264:377.CrossRefGoogle Scholar
  16. 16.
    Packer DL, Bardy GH, Worley SJ et al. Tachycardia-induced cardiomyopathy: a reversible form of left ventricular dysfunction. Am J Cardiol. 1986;57:563.PubMedCrossRefGoogle Scholar
  17. 17.
    Grogan M, Smith HC, Gersh BJ, Wood DW. Left ventricular dysfunction due to atrial fibrillation in patients initially believed to have idiopathic dilated cardiomyopathy. Am J Cardiol. 1992;69:1570.PubMedCrossRefGoogle Scholar
  18. 18.
    Middlekauff HR, Weiner I. Stevenson WG, Saxon LA, Stevenson LW. Lou dose amiodarone for atrial fibrillation in advanced heart failure restores sinus rhythm and improves functional capacity. Circulation. 1992;86:1–808.Google Scholar
  19. 19.
    Alexander JK. The cardiomyopathy of obesity. Prog Cardiovasc Dis. 1985;27:325.PubMedCrossRefGoogle Scholar
  20. 20.
    Stevenson LW. Tailored therapy before transplantation for treatment of advanced heart failure: effective use of vasodilators and diuretics. J Heart Lung Transplant. 1991;10:468.PubMedGoogle Scholar
  21. 21.
    Stevenson LW, Perloff JK. The limited reliability of physical signs for the estimation of hemodynamics in chronic heart failure. J Am Med Assoc. 1989;261:884.CrossRefGoogle Scholar
  22. 22.
    Stevenson LW, Tillisch JH. Maintenance of cardiac output with normal filling pressures in dilated heart failure. Circulation. 1986;74:1303.PubMedGoogle Scholar
  23. 23.
    Stevenson LW, Brunken RC, Belil D et al. Afterload reduction with vasodilators and diaretics decreases mitral valve regurgitation during upright exercise in advanced heart failure. J Am Coll Cardiol. 1990;15:174.PubMedGoogle Scholar
  24. 24.
    Mudge GH, Goldstein S, Addonizio LJ et al. Task force 3: recipient guidelines/ prioritization. J Am Cull Cardiol. 1993;22:21.Google Scholar
  25. 25.
    Steimle AE, Slevenson LW, Chelimsky-Fallick C, Fonarow GA, Tillisch JH. Prolonged maintenance of cardiac output with normal filling pressures during chronic therapy for advanced heart failure. Circulation. 1993;88:1–59A.Google Scholar
  26. 26.
    Hamilton MA, Stevenson LW, Child JS et al. Sustained reduction in valvular regurgitation and atrial volumes with tailored vasodilator therapy in advanced congestive heart failure secondary to dilated cardiomyopathy. Am J Cardiol. 1991;67:259.PubMedCrossRefGoogle Scholar
  27. 27.
    Fonarow GC. Stevenson LW, Walden JA et al. Impact of a comprehensive management program on the hospitalization rate for patients with advanced heart failure (ACC abstract ref. 1995).Google Scholar
  28. 28.
    Waagstein F, Caidahl K. Wallentin I, Bergh C-H. Hjalmarson A. Long-term betablockade in congestive cardiomyopathy: effects of short and long-term metoprolol treatment followed by withdrawal and readmission of metoprolol. Circulation. 1989;80:551.PubMedGoogle Scholar
  29. 29.
    Waagstein F, Bristow MR, Swedberg K et al. Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Lancet. 1993;342:1442.CrossRefGoogle Scholar
  30. 30.
    Erlebacher JA, Bhardwaj M, Suresh A, Leber GB, Goldweit RS. Beta-blocker treatment of idiopathic and ischemic dilated cardiomyopathy in patients with ejection fractions-20%. Am J Cardiol. 1993;71:1467.PubMedCrossRefGoogle Scholar
  31. 31.
    Hamer AWF, Arkles LB, Johns JA. Benelicial effects of low dose amiodarone in patients with congestive heart failure: a placebo-controlled trial. J Am Coll Cardiol. 1989;14:1768.PubMedGoogle Scholar
  32. 32.
    Doval HC, Nul DR, Grancello et al. Randomized trial of low-dose amiodarone in severe congestive heart failure. Lancet. 1994;344:493.PubMedCrossRefGoogle Scholar
  33. 33.
    Singh SN, Fletcher RD, Fisehr SG et al. Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia. N Engl J Med. 1995;333:77.PubMedCrossRefGoogle Scholar
  34. 34.
    Wilson JR, Schwartz JS, St. John Sutton M et al. Prognosis in severe heart failure: relation to hemodynamic measurements and ventricular eclopic activity. J Am Coll Cardiol. 1983;2:403.PubMedGoogle Scholar
  35. 35.
    DiSalvo TG, Mathier M, Semigran MJ, Dec GW. Preserved right ventricular ejection fraction predicts exercise capacity and survival in advanced heart failure. J Am Coll Cardiol. 1995;25:1143.CrossRefGoogle Scholar
  36. 36.
    Lee WH, Packer M. Prognostic importance of serum sodium concentration and its modification by converting enzyme inhibition in patients with severe chronic heart failure. Circulation. 1986;73:257.PubMedGoogle Scholar
  37. 37.
    Cohn JN, Levine TB, Olivari MT et al. Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med. 1984;311:819.PubMedGoogle Scholar
  38. 38.
    Steimle AE, Stevenson LW, Hamilton MA, Fonarow GA. Prediction of spontaneous improvement in recent onset cardiomyopathy after referral for transplantation. Circulation. 1993;88:1–93A.Google Scholar
  39. 39.
    Stevenson LW. Fonarow G, Hamilton M, Tillisch JH. Why cardiac output is not a good hemodynamic target for therapy in advanced heart failure. Circulation. 1994;90:1–611.Google Scholar
  40. 40.
    Stevenson WG, Stevenson LW, Middlekauff HR, Saxon LA. Sudden death prevention in patient with advanced left ventricular dysfunction. Circulation. 1993;88:2953.PubMedGoogle Scholar
  41. 41.
    O’Connell JB, Gunnar RM, Evans RW, Fricker FJ et al. Task force 1: organization of heart transplantation in the U.S. J Am Coll Cardiol. 1993;22:8.PubMedGoogle Scholar
  42. 42.
    Keogh AM, Freund J, Baron DW, Hickie JB. Timing of transplantation in idiopathic dilated cardiomyopathy. Am J Cardiol. 1988;61:418.PubMedCrossRefGoogle Scholar
  43. 43.
    Stevenson LW, Couper G, Natterson BJ et al. Target heart failure population for new therapies. Circulation. 1995 (In press).Google Scholar
  44. 44.
    Lee TH, Hamilton MA, Stevenson LW et al. Impact of left ventricular cavity size on survival in advanced heart failure. Am J Cardiol. 1993;72:672.PubMedCrossRefGoogle Scholar
  45. 45.
    Cohn J, Johnson G, Shabetai R et al. Ejection fraction, peak exercise oxygen consumption, cardiothoracic ratio, ventricular arrhythmias, and plasma norepinephrine as determinants of prognosis in heart failure. Circulation. 1993;87(Suppl.VI):VI5.PubMedGoogle Scholar
  46. 46.
    Szlachic J, Massie B, Kramer B, Topic N, Tubau J. Correlates and prognostic implication of exercise capacity in chronic congestive heart failure. Am J Cardiol. 1985;55:1037.CrossRefGoogle Scholar
  47. 47.
    Likoff M, Chandler S, Kay H. Clinical determinants of mortality in chronic congestive heart failure secondary to idiopathic dilated or ischemic caridomyopathy. Am J Cardiol. 1987:59:634.PubMedCrossRefGoogle Scholar
  48. 48.
    Mancini DM, Eisen H, Kussmaul W et al. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation. 1991;83:778.PubMedGoogle Scholar
  49. 49.
    Haywood GA, Rickenbacher PR, Trindade PT et al. Deaths in patients awaiting heart transplantation: the need to identify high risk category two patients. Circulation. 1994;90:1–360.Google Scholar
  50. 50.
    Stevenson LW, Steimle AE, Chelimsky-Fallick C et al. Outcomes predicted by peak oxygen consumption during evaluation of 333 patients with advanced heart failure. Circulation. 1993;88:1–94A.Google Scholar
  51. 51.
    Stevenson LW, Steimle AB, Fonarow G et al. Improvement in exercise capacity of candidates awaiting heart transplantation. J Am Coll Cardiol. 1995;25:163.PubMedCrossRefGoogle Scholar
  52. 52.
    Stevenson LW, Sietsema K, Tillisch JH et al. Exercise capacity for survivors of cardiac transplantation or sustained medical therapy for stable heart failure. Circulation. 1990;81:78.PubMedGoogle Scholar
  53. 53.
    Walden JA, Stevenson LW, Dracup K et al. Extended comparison of quality of life between stable heart failure patient and heart transplant recipients. J Heart Lung Transplant. 1994;13:1109.PubMedGoogle Scholar
  54. 54.
    Stevenson LW, Miller L. Cardiac transplantation as therapy for heart failure. Curr Prob Cardiol. 1991;16:219.CrossRefGoogle Scholar
  55. 55.
    Olivari MT, Antolick A, Kaye MP, Jamieson SW, Ring WS. Heart transplantation in elderly patients. J Heart Transplant. 1988;7:258.PubMedGoogle Scholar
  56. 56.
    Grattan MT, Moreno-Cabral CE, Starnes VA et al. Eight-year results of cyclosporintreated patients with cardiac transplants. J Thorac Cardiovasc Surg. 1990;99:500.PubMedGoogle Scholar
  57. 57.
    Kaye MP. Registry of the International Society for Heart and Lung Transplantation: Tenth official report-1993. J Heart Lung Transplant. 1993;12:541.PubMedGoogle Scholar
  58. 58.
    Hosenpud JD, DeMarco T, Frazier H et al. Progression of systemic disease and reduced long-term survival in patients with cardiac amyloidosis undergoing heart transplantation. Circulation. 1991;84:111–338.Google Scholar
  59. 59.
    Stolf NAG, Higushi L, Bocchi E et al. Heart transplantation in patients with Chagas’ disease cardiomyopathy. J Heart Transplant. 1987;5:307.Google Scholar
  60. 60.
    Copeland JG, Emery RW, Levinson MM et al. Selection of patients for cardiac transplantation. Circulation. 1987;75:2.PubMedGoogle Scholar
  61. 61.
    Olbrisch ME, Levenson JL. Psychological evaluation of heart transplantation candidates: an international survey of process, criteria and outcomes. J Heart Lung Transplant. 1991;10:948.PubMedGoogle Scholar
  62. 62.
    Rodriguez MD, Colon A, Santiago-Delphin EA. Psychosocial profile of non-compliant patients. Transplant Proc. 1991;23:1807.PubMedGoogle Scholar
  63. 63.
    Herrick CM, Mealey PC, Tischner LL. Holland CS. Combined heart failure-transplant program: advantages in assessing medical compliance. J Heart Transplant. 1987;6:141.PubMedGoogle Scholar
  64. 64.
    Penn I. Cancers after cyclosporin therapy. Transplant Proc. 1988;20:276.PubMedGoogle Scholar
  65. 65.
    Erickson KW, Costanzo-Nordin MR, O’Sullivan EJ et al. Influence of preoperative transpulmonary gradient on late mortality after orthotopic heart transplantation. J Heart Transplant. 1990;9:526.PubMedGoogle Scholar
  66. 66.
    Costard-Jackle A, Fowler MB. Influence of preoperative pulmonary artery pressure on mortality after heart transplantation: testing of potential reversibility of pulmonary hypertension with nitroprusside is useful in defining a high risk group. J Am Coll Cardiol. 1992;19:48.PubMedGoogle Scholar
  67. 67.
    Kaye MP. The Registry of the International Society for Heart and Lung Transplantation, Ninth official report. J Heart Lung Transplant. 1992;599:11.Google Scholar
  68. 68.
    Desruennes M, Muneretto C, Gandjbakhch 1 et al. Heterotopic heart transplantation: current status in 1988. J Heart Transplant. 1989;8:479.PubMedGoogle Scholar
  69. 69.
    Wright RS, Levine MS, Bellamy PE et al. Ventilatory and diffusion abnormalities in potential heart-transplant recipients. Chest. 1990;98:816.PubMedGoogle Scholar
  70. 70.
    Radovancevic B, Poindexter S, Birovljev S et al. Risk factors for development of accelerated coronary artery disease in cardiac transplant recipients. Eur J Cardiothorac Surg. 1990;4:309.PubMedCrossRefGoogle Scholar
  71. 71.
    Myers BD, Peterson C, Molina C et al. Role of cardiac atria in the human renal response to changing plasma volume. Am J Physiol. 1988;254:F562.PubMedGoogle Scholar
  72. 72.
    Wei CM, Kao PC, Lin JT, Heublein DM, Schaff HV, Burnett JC Jr: Circulating β atrial natriuretic factor in congestive heart failure. Circulation. 1993;88:1016.PubMedGoogle Scholar
  73. 73.
    Bourge RC, Naftal DC, Costanzo M et al. Risk factors for death after cardiac transplantation: a multi-institutional study. J Heart Lung Transplant. 1993;12:549.PubMedGoogle Scholar
  74. 74.
    Laffel GL, Barnett Al, Finkelstein S et al. The relation between experience and outcome in heart transplantation. N Engl J Med. 1992;327:1220.PubMedGoogle Scholar
  75. 75.
    Flaker GC, Blackshear JL, McBride R et al. Antiarrhythmic drug therapy and cardiac mortality in atrial fibrillation. The Stroke Prevention in Atrial Fibrillation Investigators. J Am Coll Cardiol. 1992;20:527.PubMedCrossRefGoogle Scholar
  76. 76.
    Natterson PD, Stevenson WG, Saxon LA, Middlekauff HR, Stevenson LW. Risk of arterial embolization in 224 patients awaiting cardiac transplantation. Am Heart J. 1995;129:564.PubMedCrossRefGoogle Scholar
  77. 77.
    Konstam MA, Dracup K, Baker DW et al. Heart failure: evaluation and care of patients with left-ventricular systolic dysfunction. Rockvillc, M: US Dept. of Health and Human Services; 1994.Google Scholar
  78. 78.
    Chelimsky-Fallick C, Middlekauff HR, Stevenson WG et al. Amiodarone therapy does not compromise subsequent heart transplantation. J Am Coll Cardiol. 1992;20:1556.PubMedGoogle Scholar
  79. 79.
    Stevenson LW, Warner SL, Steimle AE et al. The impending crisis awaiting cardiac transplantation: modeling a solution based on selection. Circulation. 1994;89:450.PubMedGoogle Scholar
  80. 80.
    Norman JC, Colley DA, Igo SR et al. Prognostic indices for survival during postcardiotomy intra-aorlic balloon pumping. J Thorac Cardiovasc Surg. 1977;74:709.PubMedGoogle Scholar
  81. 81.
    Loisance DY, Deleuze PH, Houel K et al. Pharmacologic bridge to cardiac transplantation: current limitations. Ann Thorac Surg. 1993;55:310.PubMedGoogle Scholar
  82. 82.
    McCarthy PM, Sabik JF. Implantable circulatory support devices as a bridge to heart transplantation. Semin Thorac Cardiovasc Surg. 1994;6:174.PubMedGoogle Scholar
  83. 83.
    Evans RW. Executive summary: The National Cooperative Transplantation Study. Report BHARC-100-91-020. Seattle: Battelle Seattle Research Center, June 1991.Google Scholar
  84. 84.
    Pfeffer MA, Braunwald E, Moye LA et al. (on behalf of the SAVE investigators). Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction: results of the survival and ventricular enlargement trial. N Engl J Med. 1992;327:669.PubMedGoogle Scholar
  85. 85.
    The SOLVD Investigators: Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med. 1991;325:293Google Scholar
  86. 86.
    CONSENSUS trial study group. Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative New Scandinavian Enalapril Survival Study. N Engl J Med. 1987;316:1429.Google Scholar
  87. 87.
    Stevenson LW, Role of exercise in the evaluation of candidates for cardiac transplantation: In: Wasserman K, editor. Exercise gas exchange in heart disease. New York: Futura; 1995 (In press).Google Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • L. W. Stevenson

There are no affiliations available

Personalised recommendations