End-Stage Heart Failure and Timing of Heart Transplantation

  • M. F. Leonen
  • J. B. O’Connell
Conference paper


During the 30 years since the first successful operation, cardiac transplantation has evolved to a procedure of choice in heart failure patients who have otherwise dismal short term prognosis. Refinements in surgical approach, tissue preservation, immunology and infectious disease control have produced survival rates up to 85% at one year and 70% at five years [1]. By operational definition, patients with refractory symptoms whose prognoses are estimated to be worse than transplantation should be considered in end-stage heart failure.


Heart Failure Heart Transplantation Cardiac Transplantation Chronic Congestive Heart Failure Heart Lung Transplant 
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.
    Hosenpud JD, Novick RJ, Bennett L Keck BN, Fiol B, Dair OP (1996) The Registry of the International Society for Heart and Lung Transplantation: Thirteenth Official Report-1996. J Heart and Lung Transplant 15:655–675Google Scholar
  2. 2.
    Stevenson LW (1994) Selection and management of patients for cardiac transplantation. Curr Opin Cardiol 9:315–325PubMedCrossRefGoogle Scholar
  3. 3.
    O’Connell J, Bourge R, Costanzo-Nordin M, Driscoll DJ, Morgan JP, Rose EA, Uretsky BF (1992) Cardiac transplantation: Recipient selection, donor procurement and medical follow-up. Circulation 86:1061–1079PubMedCrossRefGoogle Scholar
  4. 4.
    Costanzo M, Augustine S, Bourge R, Bristow M, O’Connell JB, Driscoll D, Rose E (1995) Selection and treatment of candidates for heart transplantation. Circulation 92:3593–3612PubMedCrossRefGoogle Scholar
  5. 5.
    Stevenson LW, Warner SL, Steimle AE, Fonarow GC, Hamilton MA, Moriguchi JD, Kobashigawa JA, Tillisch JH, Drinkwater DC, Laks H (1994) The impending crisis awaiting cardiac transplantation-Modeling a solution based on selection. Circulation 89:450–457PubMedCrossRefGoogle Scholar
  6. 6.
    Stevenson LW, Fowler MB, Schroeder SS, Stevenson WG, Dracup KA, Fond V (1987) Poor survival of patients with idiopathic cardiomyopathy considered too well for transplantation. Am J Med 83:871–976PubMedCrossRefGoogle Scholar
  7. 7.
    Keogh AM, Baron DW, Hieckie JB (1990) Prognostic guides in patients with idiopathic or ischemic dilated cardiomyopathy assessed for cardiac transplantation. Am J Cardiol. 65:903–908PubMedCrossRefGoogle Scholar
  8. 8.
    Steimle AE, Stevenson LW, Fonarow GC, Hamilton MA, Moriguchi JD (1994) Prediction of improvement in recent-onset cardiomyopathy after referral for heart transplantation. J Am Cardiol 23:553–559CrossRefGoogle Scholar
  9. 9.
    O’Connell J, Constanzo-Nordin MR, Subramanian R, Robinson JA, Wallis DE, Scanlow PJ, Gunnar RM (1986) Peripartum cardiomyopathy. Clinical, hemodynamic, histologic, and prognostic characteristics. J Am Coll Cardiol 8:52–56Google Scholar
  10. 10.
    Regan TJ (1991) Alcohol and the cardiovascular system. A review. JAMA 264:377–381CrossRefGoogle Scholar
  11. 11.
    Alexander JK (1895) The cardiomyopathy of obesity. Prog Cardiovasc Dis 27:325–334CrossRefGoogle Scholar
  12. 12.
    Middlekauff HR, Stevenson WG, Saxon LA, Stevenson LW (1992) Low dose amiodarone for atrial fibrillation in advanced heart failure restores sinus rhythm and improves functional capacity. Circulation [Suppl I] 86:1–808 (abstr)CrossRefGoogle Scholar
  13. 13.
    The CONSENSUS Trial Study Group (1987) Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med 316:1429–1435CrossRefGoogle Scholar
  14. 14.
    Packer M, O’Connor C, Ghali J, Pressler ML, Carson PE, Belkin RN, Miller AB, Neuberg GW, Frid D, Wertheimer JH, Cropp AB, DeMets DL for the Prospective Randomized Amlodipine Survival Evaluation Study Group (1996) Effect of amlodipine on morbidity and mortality in severe chronic heart failure. N Engl J Med 335:1107–1114PubMedCrossRefGoogle Scholar
  15. 15.
    Lindelow B, Andersson B, Waagstein F and Bergh CH (1995) Prognosis of alternative therapies in patients with heart failure not accepted for heart transplantation. J Heart Lung Transplant 14:1204–1211PubMedGoogle Scholar
  16. 16.
    Rajfer SI (1993) Perspective of the pharmaceutical industry on the development of new drugs for heart failure. J Am Coll Cardiol 22 [Suppl A]:198–200CrossRefGoogle Scholar
  17. 17.
    Conn JN, Johnson G, Ziesche S, Cobb F, Francis G, Tristani F, Smith R, Dunkman WB, Loeb H, Wong M (1991) A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med 325:303–310CrossRefGoogle Scholar
  18. 18.
    Packer M, Bristow M, Conn J, Colucci WS, Fowler MB, Gilbert EM, Shusterman NH (1996) The effect of Carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med 334:1349–1355PubMedCrossRefGoogle Scholar
  19. 19.
    Doval H, Nul D, Grancelli H, Perrone SV, Bortman GR, Curiel R (1994) Randomized trial of low-dose amiodarone on severe congestive heart failure. Lancet 344:493–498PubMedCrossRefGoogle Scholar
  20. 20.
    The Digitalis Investigation Group (1997) The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med 336:525–533CrossRefGoogle Scholar
  21. 21.
    Feldman AM, Young J, Bourge R et al (1997) Mechanism of increased mortality from vesnarinone un the severe heart failure trial (VesT). Circulation 29 [Suppl A]:64AGoogle Scholar
  22. 22.
    Dies F, Krell MJ, Whitlow P et al (1986) Intermittent dobutamine in ambulatory outpatients with chronic heart failure. Circulation 74 [Suppl II]:11–38Google Scholar
  23. 23.
    Ott GY, Norman D, Hosenpud J, Hersaberger RE, Ratkovec RM, Cobanoglu AM (1994) Heart transplantation patients with previous cardiac operations: excellent clinical results. J Thorac Cardiovasc Surg 107:203–209PubMedGoogle Scholar
  24. 24.
    Alderman EL, Fisher LD, Litwin P, Kaiser GC, Myers WO, Maynard C, Levine F, Schloss M (1983) Results of coronary artery surgery in patients with poor left ventricular function (CASS). Circulation 68:785–795PubMedCrossRefGoogle Scholar
  25. 25.
    Langenburg SE, Buchanan SA, Blackbourne LH, Scheri RP, Sinclair KN, Martinez J, Spotnitz WD, Trible CC, Kron IL (1995) Predicting survival after coronary revascularization for ischemic cardiomyopathy. Ann Thorac Surg 60:1193–1197PubMedCrossRefGoogle Scholar
  26. 26.
    Louie H, Laks H, Milgalter E, Drinkwater DC Jr, Hamilton MA, Brunken RC, Stevenson LW (1991) Ischemic cardiomyopathy: Criteria for coronary revascularization and cardiac transplantation. Circulation 84 [Suppl III]:290–295Google Scholar
  27. 27.
    Elefteriades J, Tolis G, Levi E, Mills K, Zaret B (1993) Coronary artery bypass grafting in severe left ventricular dysfunction: excellent survival with improved ejection fraction and functional state. J Am Coll Cardiol 22:1411–1417PubMedCrossRefGoogle Scholar
  28. 28.
    Hausmann H, Ennker J, Topp H, Schuler S, Schiessler A, Hempel B, Friedel N, Hofmeister S, Hetzer R (1994) Coronary bypass grafting and heart transplantation in end stage coronary artery disease: A comparison of hemodynamic improvement and ventricular function. J Card Surg 9:77–84PubMedCrossRefGoogle Scholar
  29. 29.
    Di Carli MF, Asgarzadie F, Schelbert HR, Brunken RC, Laks H, Phelps ME, Naddahi J (1995) Quantitative relation between myocardial viability and improvement in heart failure symptoms after revascularization in patients with ischemic cardiomyopathy. Circulation 92:3436–3444PubMedCrossRefGoogle Scholar
  30. 30.
    Carabello B (1991) Timing of surgery in mitral and aortic stenosis. Cardiology Clinics 9:229–238PubMedGoogle Scholar
  31. 31.
    Carabello BA, Green LH, Grossman W, Cohn LH, Koster JK, Collins SS (1980) Hemodynamic determinants of prognosis of aortic valve replacement in critical aortic stenosis and advanced congestive heart failure. Circulation 62:42PubMedCrossRefGoogle Scholar
  32. 32.
    Bonow R, Picone A, McIntosh C, Jones M, Rosing DR, Maron BS, Lakatos E, Clark RE, Epstein SE (1985) Survival and functional results after valve replacement for aortic regurgitation from 1976–1983: Impact of preoperative left ventricular function. Circulation 72:1244–1256PubMedCrossRefGoogle Scholar
  33. 33.
    Bonow R, Dodd J, Maron B, O’Gara PT, White CC, McIntosh CC, Clark RE, Epstein ST (1988) Long term serial changes in left ventricular function and reversal of ventricular dilatation after valve replacement for chronic aortic regurgitation. Circulation 78:1108–1120PubMedCrossRefGoogle Scholar
  34. 34.
    Lee EM, Shapiro LM, Wells FC (1996) Importance of subvalvular preservation and early operation in mitral valve surgery. Circulation 94:2117–2123PubMedCrossRefGoogle Scholar
  35. 35.
    Boiling SF, Deeb GM, Brunsting LA, Bach DS (1995) Early outcome of mitral valve reconstruction in patients with end-stage cardiomyopathy. J Thorac Cardio Surg 109:676–682CrossRefGoogle Scholar
  36. 36.
    Lee EM, Shapiro LM, Wels FC (1995) Mortality and morbidity after mitral valve repair: the importance of left ventricular dysfunction. J Heart Valve Dis 4:460–468PubMedGoogle Scholar
  37. 37.
    Sousa Uva M, Dreyfus G, Rescigno G, Al Aile N, Mascagni R, La Marra M, Povillart F, Parkaoncar S, Palsky E, Raffoul R, Scorsin M, Noera G, Lessana A (1996) Surgical treatment of asymptomatic and mildly symptomatic mitral regurgitation. J Thorac Cardio Surg 112:1240–1248CrossRefGoogle Scholar
  38. 38.
    Furnary AP, Jessup FM, Moreira LP (1996) Multicenter trial of dynamic cardiomyoplasty for chronic heart failure. The American Cardiomyoplasty Group. J Am Coll Cardiol 28:1175–1180CrossRefGoogle Scholar
  39. 39.
    Furnary AP, Chachques JC, Moreira LF, Grunkemeier GL, Swanson JS, Stolf N, Haydars S, Acar C, Starr A, Jatene AD, Carpentier AF (1996) Long term outcome, survival analysis, and risk stratification of dynamic cardiomyoplasty. J Thorac Cardio Surg 112:1640–1649CrossRefGoogle Scholar
  40. 40.
    Communication, American College of Cardiology 46th Annual Scientific Session, Anaheim, USA, March 1997Google Scholar
  41. 41.
    Massad MG, McCarthy PM, Smedira NG, Miller CA, Pierce WS (1996) Does successful bridging with the implantable left ventricular device affect cardiac transplantation outcome? J Thorac Cardio Surg 112:1275–1281CrossRefGoogle Scholar
  42. 42.
    Mehta SM, Aufiero TX, Pae WE, Miller CA, Pierce WS (1995) Combined registry for the clinical use of mechanical ventricular assist pumps and the total artificial heart in conjunction with heart transplantation: sixth official report 1994. J Heart Lung Transplant 14:585–593PubMedGoogle Scholar
  43. 43.
    Mehta SM, Aufiero TX, Pae WE, Miller CA, Pierce WS (1995) Mechanical ventricular assistance: an economical and effective means of treating end stage heart disease. Ann Thorac Surg 60:284–290PubMedCrossRefGoogle Scholar
  44. 44.
    Hosenpud JD, De Marco T, Frazier H, Griffith BP, Uretsky BF, Mekisah H, O’Connell JB, Olivari MT, Valantine HA (1991) Progression of systemic disease and reduced long term survival in patients with cardiac amyloidosis undergoing heart transplantation. Circulation [Suppl III] 84:338–343Google Scholar
  45. 45.
    Oni AA, Hershberger RE, Norman DJ, Ray J, Hovaguinian N, Cobanoglu AM, Hosenpud JD (1991) Recurrence of sarcoidosis in a cardiac allograft: Control with augmented corticosteroids. J Heart Transplant 11:367–369Google Scholar
  46. 46.
    Stolf NAG, Higushi L, Bocchi E, Bellotti O, Auler JO, Vip D, Amatoneto V, Pileggi F, Jatenz AD (1987) Heart transplantation in patients with Chagas disease cardiomyopathy. J Heart Transplant 6:307–312PubMedGoogle Scholar
  47. 47.
    Loria K, Jessurun J, Shumway S, Kubo S (1994) Early recurrence of chronic active myocarditis after heart transplantation. Hum Pathol 25:323–326PubMedCrossRefGoogle Scholar
  48. 48.
    Miller L, Kubo S, Young J, Stevenson LW, Loh E, Costanzo MR (1995) Report of the consensus conference on candidate selection for heart transplantation-1993. J Heart Lung Transplant 14:562–571PubMedGoogle Scholar
  49. 49.
    Rees W, Schuler S, Hummel M, Hetzer R (1993) Heart transplantation in patients with muscular dystrophy associated with end stage cardiomyopathy. J Heart Lung Transplant 12:804–807PubMedGoogle Scholar
  50. 50.
    Dillon T, Sullivan M, Ladowski J, Schatzlein MH, Peterson AC, Scheeringa RA, Clark WR Jr, Ladowski JS (1991) Cardiac transplantation in patients with preexisting malignancies. Transplantation 52:82–85PubMedCrossRefGoogle Scholar
  51. 51.
    Pulpon LA, Crespo MG, Sobrino M, Segovia J, Ortigosa J, Burgos R, Silva L, Serrano S, Artzara M, Tellel G (1994) Recalcitrant endocarditis successfully treated by heart transplantation. Am Heart J 127:958–960PubMedCrossRefGoogle Scholar
  52. 52.
    Park S, Sullivan H, Lonchyna V et al (1993) Heart transplantation for complicated and recurrent early prosthetic valve endocarditis. J Heart Lung Transplant 12:802–203PubMedGoogle Scholar
  53. 53.
    Munoz E, Lonquist J, Frazier O, Radovancevic B, Baldwin RT, Ford S, Duncan JM, Frazieroa (1992) Long term results in diabetic patients undergoing heart transplantation. J Heart Lung Transplant 11:943–949PubMedGoogle Scholar
  54. 54.
    Bergin P, Rabinov M, Esmore D (1995) Cardiac transplantation in patients over 60 years. Transplant Proc 27:2150–2151PubMedGoogle Scholar
  55. 55.
    Heroux A, Costanzo-Nordin MR, O’Sullivan J, Kao WG, Liao Y, Mullen GM, Johnson MR (1993) Heart transplantation as a treatment option for end stage heart disease in patients older than 65 years of age. J Heart Lung Transplant 12:573–579PubMedGoogle Scholar
  56. 56.
    Aaronson K, Schwartz S, Goin J, Mancini D (1995) Sex differences in patient acceptance of cardiac transplant candidacy. Circulation 91:2753–2761PubMedCrossRefGoogle Scholar
  57. 57.
    Crandall B, Renlund D, O’Connell J, Burton NA, Jones KW, Gay WA Jr, Doty DB, Karwande SV, Lee HR, Holland C (1988) Increased cardiac allograft rejection in female heart transplant recipients. J Heart Transplant 7:419–423PubMedGoogle Scholar
  58. 58.
    Wechler M, Giardina E, Sciacca R, Rose E, Barr M (1995) Increased mortality in women undergoing cardiac transplantation. Circulation 91:1029–1035CrossRefGoogle Scholar
  59. 59.
    Kirklin JK, Naftel DC, Kirklin JW, Blackstone EH, White-Williams C, Bourge RC, (1988) Pulmonary vascular resistance and the risk of heart transplantation. J Heart Transplant 7:331–336PubMedGoogle Scholar
  60. 60.
    Costard-Jale A, Fowler MB (1992) 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 19:48–54Google Scholar
  61. 61.
    Murali S, Uretsky BF, Armitage JA, Tokarczyk TR, Betschart AR, Kormos RL, Stein KL, Reddy PS, Hardesty RL, Griffith P (1992) Utility of prostaglandin El in the pretransplantation evaluation of heart failure patients with significant pulmonary hypertension. J Heart Lung Transplant 11:716–723PubMedGoogle Scholar
  62. 62.
    Haywood G, Sneddon B, Bashir Y, Jennison SH, Gray HH, McKenna WS (1992) Adenosine infusion for the reversal of pulmonary vasoconstriction in biventricular failure — a good test but a poor therapy. Circulation 86:892–902CrossRefGoogle Scholar
  63. 63.
    Light RW, George RB (1983) Serial pulmonary function in patients with acute heart failure. Arch Intern Med 143:429–433PubMedCrossRefGoogle Scholar
  64. 64.
    Levy R, Guerraty A, Yacub M, Loertscher R (1993) Prolonged survival after heart-lung transplantation in systemic lupus erythematosus. Chest 104:1903–1905PubMedCrossRefGoogle Scholar
  65. 65.
    Gonwa T, Husberg B, Klintmakn G (1992) Simultaneous heart and kidney transplantation: a report of three cases and review of literature. J Heart Lung Transplant 11:152–155PubMedGoogle Scholar
  66. 66.
    Olivieri N, Liu PP, Shern G, Olivieri MF, Lio PP, Osherm CD, Daly PA, Greig PD, McCusker PJ, Collins AF, Fracombe WH, Templeton DM, Butany J (1994) Brief report: combined liver and heart transplantation for end-stage iron-induced organ failure in an adult with homozygous beta-thalassemia. N Engl J Med 330:1125–1127PubMedCrossRefGoogle Scholar
  67. 67.
    Rodriguez MD, Colon A, Santiago-Delphin EA (1991) Psychosocial profile of noncompliant patients. Transplant Proc 23:1807–1909PubMedGoogle Scholar
  68. 68.
    Massie BM, Conway M (1987) Survival of patients with congestive heart failure: Past, present, and future prospects. Circulation 75 [suppl IV]:IV–11Google Scholar
  69. 69.
    Griffin BP, Shah PK, Ferguson J, Rubin SA (1991) Incremental prognostic value of exercise hemodynamic variables in chronic congestive heart failure secondary to coronary artery disease or to dilated cardiomyopathy. Am J Cardiol 67:848–853PubMedCrossRefGoogle Scholar
  70. 70.
    Mancini DM, Eisen H, Kussmaul W, Mull R, Edmunds LH Jr, Wilson Jr (1991) Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation 83:778–786PubMedCrossRefGoogle Scholar
  71. 71.
    Di Salvo T, Mathier M, Semigran MJ, Dec W (1995) Preserved right ventricular ejection fraction predicts exercise capacity and survival in advanced heart failure. J Am Coll Cardiol 25:1143–1153PubMedCrossRefGoogle Scholar
  72. 72.
    Dec GW, Fifer MA, Hermann HC, Cocca-Spofford D, Semigran MJ (1993) Long term outcome of enoximone therapy in patients with refractory heart failure. Am Heart J 125:423–429PubMedCrossRefGoogle Scholar
  73. 73.
    Wilson JR, Schwartz JS, Sutton JSJ, Ferraro N, Horowitz LN, Reicher N, Josephson MG (1983) Prognosis in severe heart failure: Relation to hemodynamic measurements and ventricular ectopic activity. J Am Coll Cardiol 2:403–410PubMedCrossRefGoogle Scholar
  74. 74.
    Morley D, Brozena SC (1994) Assessing risk by hemodynamic profile in patients awaiting cardiac transplantation. Am J Cardiol 75:379–383CrossRefGoogle Scholar
  75. 75.
    Kopelev B, Chestukhin V, Mironov B, Golovchiwer GN, Mogilevsky GN, Shumacov VI (1992) Heart transplantation: Additional criteria for patient selection. Trans Proc 24:2006Google Scholar
  76. 76.
    Conn JN, Levine TB, Olivari MT (1984) Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med 311:819–823CrossRefGoogle Scholar
  77. 77.
    Nicklas JM, Benedict C, Johnstone DE, Kay R, Kirklin PC, Weiner D, Bourassa MG, Yusuf S (1991) Relationship between neurohormonal profile and one year mortality in patients with CHF and/or LV dysfunction. Circulation (suppl II) 11–468Google Scholar
  78. 78.
    Luciani G, Livi U, Faggian G, Mazzucco A (1992) Clinical results of heart transplantation in recipients over 55 years of age with donors over 40 years of age. J Heart Lung Transplant 11:1177–1183PubMedGoogle Scholar
  79. 79.
    Sethi G, Lanauze P, Rosado L et al (1993) Clinical significance of weight difference between donor and recipient in heart transplantation. J Thorac Cardiovasc Surg 108:444–448Google Scholar
  80. 80.
    Kao W, McGee D, Liao Y, Heroux AL, Mullen GM, Johnson MR, Costanzo MR (1994) Does heart transplantation confer additional benefit over medical therapy to patients who have waited > 6 months for heart transplantation? J Am Coll Cardiol 24:1547–1551PubMedCrossRefGoogle Scholar
  81. 81.
    Stevenson L, Steimle A, Fonarow G, Kermani M, Kermani D, Hamilton MA, Moriguchi SD, Waiden S, Tillisch JA, Drinkwater DC, Laks H (1995) Improvement in exercise capacity of candidates awaiting heart transplantation. J Am Coll Cardiol 25:163–170PubMedCrossRefGoogle Scholar
  82. 82.
    O’Connell J, Bristow M (1993) Economic impact of heart failure in the United States: time for a different approach. J Heart Lung Transplant 13:S107–112Google Scholar

Copyright information

© Springer-Verlag Italia 1998

Authors and Affiliations

  • M. F. Leonen
  • J. B. O’Connell

There are no affiliations available

Personalised recommendations