When Is Emergency Heart Transplantation Required?

Emergency heart transplantation is rarely viewed as a therapy for end-stage heart failure now that ventricular assist devices have been incorporated into the arsenal of most transplant centers. Only rapidly deteriorating transplant candidates requiring continuous intravenous inotrope therapy could be considered eligible. However, in a setting of acute decompensation due to myocardial infarction, open heart surgery, or myocarditis, emergency transplantation is seldom a valid option. Good supportive therapy and a wait-and-see policy may allow at least partial recovery and time in which to reconsider the transplant indication.

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Rapidly deteriorating patients who fail to respond to supportive therapy are at a too high a risk to undergo urgent or emergency transplantation and are better served by ventricular assist device implantation. No randomized studies are available on this issue, which can currently only be answered on the basis of single-center experience.

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Spes CH, Klauss V, Mudra H, et al. Diagnostic and prognostic value of serial dobutamine stress echocardiography for noninvasive assessment of cardiac allograft vasculopathy: a comparison with angiography and intravascular ultrasound. Circulation. 1999;100:509-515.

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Keywords.

Management; heart transplantation; emergency; end-stage heart failure.

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