Cardiac transplantation is still the method of choice in the treatment of patients with severe heart failure

Abstract

A significant progress in the treatment of heart failure occurred during the last 20 years. These advances were associated with the introduction and subsequent widespread use of angiotensin- -converting enzyme inhibitors and beta blockers, but also with progress in device therapy and cardiac surgery. Overall, prognosis in patients with severe heart failure is similar to outcomes reported in multicenter randomized clinical trials, such as CONSENSUS, CIBIS II, MERIT-HF, and COPERNICUS. In 2003–2007, a registry of patients with severe heart failure was established in Poland (POLKARD-HF) that included all patients initially considered candidates for heart transplantation (HTX). Mean duration of follow-up was 601 days (range 1-1462 days). One-year mortality (defined as death or super-urgent HTX) was 20% and differed from data presented by Stewart (2001). In addition, patient survival in the POLKARD-HF registry depending on the New York Heart Association (NYHA) class changed significantly in comparison to outcomes reported in the late 1980s. However, one-year mortality among NYHA class IV patients is still high and exceeds 50%. As reported in the POLKARD-HF registry, one- -year risk of death among patient who underwent elective HTX was about 20%, and 3-year risk was about 22%, significantly different from the risk of death among medically treated patients with heart failure. These results are similar to other European data and warrant reconsideration of appropriatness of HTX in elective patients (UNOS 2 status). Undoubtedly, NYHA class IV patients are candidates for HTX and should remain under specialist care in cardiac transplantation centers, and HTX should be performed in this group when indications for this procedure become urgent (UNOS 1 and 1a status).
A specialized system of care for patients with severe heart failure should be created in Poland, particularly for patients referred for HTX. There is also an urgent need to introduce modern systems of mechanical cardiac support (left ventricular assist devices, LVAD) that would allow precise determination of indications and contraindications to HTX and create opportunities for long-term treatment.