Will We Still Be Doing Heart Transplants in 10 Years?

Abstract

The likelihood that the incidence of advanced heart failure will significantly diminish in the future is not high. Over the past 50 years human heart transplantation has been performed in tens of thousands with end-stage heart failure to forestall misery and premature death. But will that operation still be done in a decade? Tremendous, but still insufficient, insight into heart transplant patient selection and management has accrued. Reasonable short and longer term survival is now seen with the postoperative half-life of recipients in the range of 12 years. However, significant comorbidities occur with substantial frequency, including hypertension, diabetes, hyperlipidemia, renal dysfunction, and allograft vasculopathy. Unfortunately an inadequate number of available donor hearts is a gruesome governor. Over roughly the same period of time, mechanical circulatory assist and replacement devices evolved as a bridge-to-transplant or “destination” therapy (meaning the device would be left in place for a lifetime). A hope has been that these machines would ameliorate the donor organ shortage while improving clinical outcomes compared to heart transplantation by offering an off-the-shelf alternative that had comparable, at the least, outcomes. Will these pumps, or even the much hyped cell transplant procedures, replace the need for heart transplant?