Table 4. Common indications and contraindications of heart transplantation.
| Indication | ||
|---|---|---|
| Uncontrolled HF symptoms despite optimal medical and appropriate device therapy | ||
| Persistent NYHA functional class IIIb-IV | ||
| Cardiopulmonary exercise result: | ||
| 1) Peak VO2 ≤14 mL/kg/min (for non-BB users) or ≤12 mL/kg/min (for BB users) | ||
| 2) Peak VO2 ≤50% of predicted for young (<50 years) patients | ||
| 3) VE/VCO2 slope >35 for sub-maximal exercise (RER <1.05) | ||
| Cardiogenic shock not expected to improve | ||
| Acute myocardial infarction | ||
| Acute myocarditis | ||
| Refractory angina despite medical therapy | ||
| Hypertrophic or restrictive cardiomyopathy with severe symptoms | ||
| Uncontrolled ventricular arrhythmia refractory to other therapies | ||
| Congenital heart disease without significant, irreversible pulmonary hypertension | ||
| Non-metastasized intra-cardiac tumor | ||
| Contraindication | ||
| Age | ≥70 years | |
| Obesity | BMI >35 kg/m2 | |
| Infection | Active infection | |
| Cancer | Presence of active malignancy, treated malignancy within 5 years | |
| Diabetes | Uncontrolled diabetes or associated significant organ injury | |
| Peripheral arterial disease | Severe vascular disease not amendable to revascularization | |
| Substance abuse | At least 6 months of abstinence of smoking, alcohol, and illicit drugs | |
| Psychosocial problems | Non-compliance, lack of caregiver support, dementia | |
BB = beta-blocker; BMI = body mass index; HF = heart failure; NYHA = New York Heart Association; RER = respiratory exchange ratio; VE/VCO2 = ventilation equivalent of carbon dioxide; VO2 = oxygen consumption.