Heart Transplant: Current Indications and Patient Selection


Book Description

Heart transplant remains the gold standard treatment for end-stage heart failure, in spite of the recent advances in pharmacological treatment and device therapy. As expected, since the first heart transplant was performed 50 years ago, outcomes in heart transplant have continued to improve over the last decades focusing on perioperative management, the availability of newer and better mechanical circulatory support before and after heart transplant and immunosuppressive drug development. Nonetheless, in the last years we have witnessed a significant drop in the heart donor's pool as the greatest limiting factor, coupled with a rising number of advanced heart failure patients. Moreover, the difficulty in handling these patients, with multiple and more complex comorbidities, is continuously increasing. More importantly and despite these difficulties, conditional half-life in transplanted patients has nowadays reached 12 years of life expectancy. Thus, besides trying to increase donor numbers, candidate selection emerges as one of the most challenging issues for heart transplant programs. In this chapter we review the latest knowledge on indications for heart transplant, as well as the available screening and optimization tools in candidate selection in order to continue improving outcomes.




Heart Transplantation


Book Description

One of the most challenging scientific steps of the modern era has been the ability to replace, functionally or anatomically, the failing heart, and in December 2017 we celebrated the 50th anniversary of the world's first human heart transplant. Despite a long and troubled hystory, heart transplantation has dramatically expanded over time, and is currently the ""gold standard"" solution in terms of treatment of refractory end-stage heart failure. Thanks to the contributions by well-known experts in the field, the goal of this book is to provide a framework for successful transplant program development and management. The text reflects the global collective efforts of those who have dedicated countless energy to achieving a better understanding of the details that will ultimately yield better outcomes in terms of teamwork.




Heart Transplantation


Book Description

Heart failure is an increasingly prevalent syndrome worldwide with a high impact on quality of life and survival. Although there have been great advances in the treatment of this condition that effectively increase survival, mortality remains unacceptably high, exceeding 40% at 5 years, which is worse than a large number of cancers. Furthermore, patients with advanced heart failure are a particular subgroup with higher hospitalizations and mortality, with a short-term survival that can be as low as 50% in the case of cardiogenic shock. Heart transplantation remains the gold standard treatment for these patients when other pharmacological and non-pharmacological interventions have failed, with a 1-year survival of approximately 90%. However, not all patients are suitable candidates for this procedure, and knowing the indications as well as the contraindications for heart transplantation is essential for appropriate patient selection. Heart Transplantation: Indications, Postoperative Management and Long-Term Outcomes is a highly illustrated, didactic book that comprehensively describes the pretransplant assessment of the advanced heart failure patient, the perioperative management of heart transplantation, and the early and late complications of the heart transplant recipient. It also covers special situations in heart transplantation such as Chagas cardiomyopathy, congenital heart disease, hypertrophic/restrictive cardiomyopathy and pediatric heart transplantation. This book is intended for cardiology fellows in training, surgeons, cardiologists, internists, and other health professionals involved in the care of heart transplant patients.




Clinical Guide to Heart Transplantation


Book Description

This is a concise review of up-to-date concepts and techniques in the discipline of heart transplantation. It is a review and reference for practitioners managing patients with advanced heart disease, including patients with end-stage heart failure, mechanical circulatory support or transplant recipients. Heart failure is a major public health issue, with a prevalence of over 5.8 million in the USA, and over 23 million worldwide, and rising. The lifetime risk of developing heart failure is one in five. Heart failure carries substantial morbidity and mortality, with 5-year mortality that rival those of many cancers. As heart transplantation remains the best treatment option for patients with end stage heart failure, this primer will provide valuable information and management strategies for physicians caring for these patients. Also, due to continued shortage in donor organs, heart transplantation is a limited resource – which further underscores the importance of appropriately evaluating patients for transplant candidacy and managing their pre, peri- and post-transplant care for maximum benefit and best outcomes.​




The Pathology of Cardiac Transplantation


Book Description

This is the first book to focus entirely on the role of pathology in cardiac transplantation, linked to the clinical perspective through clinical–pathological correlation, multidisciplinary team working, and collaborative research. It provides a scientific framework with up-to-date pathological protocols and classification schemes and guides the reader through the chronological phases of the transplant process in a step-by-step approach. Topics include end-stage heart failure with pathologies encountered in the native heart, current issues surrounding donor selection, the multiple faces of rejection pathology correlated with clinical management and immunology, other post-transplant complications, details of pediatric and combined heart/other organ transplantation, and a useful practical appendix. Many high-quality images and illustrative cases are presented, along with learning points and ample references. Transplantation medicine today is continuously changing as collaborative research into novel diagnostic techniques and immunosuppressive therapies translates into improved recipient management and survival. This book is aimed at practicing transplant pathologists and specialist trainees. It will also appeal to general pathologists and to physicians and surgeons involved in cardiac transplantation who need to understand the role of pathology in the clinical management of transplant recipients.




Heart Transplantation


Book Description




Core Topics in Cardiothoracic Critical Care


Book Description

Most patients with critical cardiac or thoracic conditions will at some stage pass through the cardiothoracic critical care unit. Critical care presents more complex clinical data than any other area of medicine. The new edition of Core Topics in Cardiothoracic Critical Care focuses on the latest practise in the management of patients in cardiothoracic intensive care. The practice of cardiothoracic critical care medicine is constantly evolving, and this new edition reflects the modernized learning styles for trainees. Each chapter includes key learning points as well as sample multiple choice questions and answers to assist in exam preparation. This edition also features updated chapters on ECMO, perioperative management of patients undergoing emergency cardiothoracic surgery, and advanced modes of organ support for patients. This text provides key knowledge in a concise and accessible manner for trainees, clinicians and consultants from specialities and disciplines such as cardiology and anaesthesia, and nursing and physiotherapy.




Transplantation Immunology


Book Description

Leading clinicians and scientists in solid organ transplantation review the current status of the field and describe cutting-edge techniques for detecting the immune response to the allografted organ. The authors present the latest techniques for HLA typing, detecting HLA antibodies, and monitoring T-cell response, and examine more specialized methods utilizing proteomics, laser dissection microscopy, and real-time polymerase chain reaction. The area of tolerance induction and reprogramming of the immune system is also covered, along with a discussion of up-to-date methods of organ preservation, of today's optimal immunosuppressive drug regimens, as well as the difficulty of mimicking chronic rejection in experimental models. Introductory chapters provide a theoretical update on current practices in renal, liver, islet, and lung transplantation and on the pathways of antigen presentation and chronic rejection.




Heart Failure: A Companion to Braunwald's Heart Disease E-Book


Book Description

Up-to-date, authoritative and comprehensive, Heart Failure, 4th Edition, provides the clinically relevant information you need to effectively manage and treat patients with this complex cardiovascular problem. This fully revised companion to Braunwald’s Heart Disease helps you make the most of new drug therapies such as angiotensin receptor neprilysin inhibitors (ARNIs), recently improved implantable devices, and innovative patient management strategies. Led by internationally recognized heart failure experts Dr. G. Michael Felker and Dr. Douglas Mann, this outstanding reference gives health care providers the knowledge to improve clinical outcomes in heart failure patients. Focuses on a clinical approach to treating heart failure, resulting from a broad variety of cardiovascular problems. Covers the most recent guidelines and protocols, including significant new updates to ACC, AHA, and HFSA guidelines. Covers key topics such as biomarkers and precision medicine in heart failure and new data on angiotensin receptor neprilysin inhibitors (ARNIs). Contains four new chapters: Natriuretic Peptides in Heart Failure; Amyloidosis as a Cause of Heart Failure; HIV and Heart Failure; and Neuromodulation in Heart Failure. Covers the pathophysiological basis for the development and progression of heart failure. Serves as a definitive resource to prepare for the ABIM’s Heart Failure board exam. 2016 British Medical Association Award: First Prize, Cardiology (3rd Edition).




Contemporary Heart Transplantation


Book Description

This work provides a one-of- a-kind volume that includes all aspects of heart transplantation from its historic beginning to its current day standards which now make the procedure a long-term treatment option for heart failure patients. The subjects covered include technical aspects of the procurement and implant procedures, as well as the medical nuances of pre-operative preparation and post-transplant immunosuppression management; the current day multi-disciplinary make up of the transplant team along with information on the keys to building and running a successful transplant program; regulatory standards and listing policies and the impact of the growing mechanical circulatory support technologies on the transplant field; and emerging technologies and future possibilities. All chapters are written by experts in the field and include the most up-to-date peer reviewed studies and clinical guidelines. This book gives an ever-changing reference that will become the text of choice for those beginning or continuing their transplant careers.