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 |
HF = heart failure; NYHA = New York Heart Association; VO2 = oxygen consumption; BB = beta-blocker; VE/VCO2 = ventilation equivalent of carbon dioxide; RER = respiratory exchange ratio; BMI = body mass index.