Professional Statements and Societal Positions
American College of Cardiology Foundation and American Heart Association-2017
Guidelines from the American College of Cardiology Foundation and American Heart Association were updated in 2017.Evaluation for heart transplantation was recommended for [individuals] in whom heart failure is assessed as refractory based on New York Heart Association functional class III or IV (stage D) for heart failure after previous guideline-directed medical therapy, use of devices such as an implantable cardioverter defibrillator or a cardiac resynchronization therapy device, or surgical management.
American Heart Association-2007
TheAmerican Heart Association(2007) indicated that, based on level B (nonrandomized studies) or level C (consensus opinion of experts) evidence, heart transplantation is indicated for pediatric [individuals] as therapy for the following indications:
- Stage D heart failure (interpreted asabnormalcardiac structureand/orfunction, continuous infusion of intravenous inotropes, or prostaglandin E1to maintain patency of a ductus arteriosus, mechanical ventilatory and/or mechanical circulatory support) associated with systemic ventricular dysfunction in [individuals] with cardiomyopathies or previous repaired or palliated congenital heart disease,
- Stage C heart failure (interpreted as abnormal cardiac structure and/or function and past or present symptoms of heart failure) associated with pediatric heart disease and severe limitation of exercise and activity, in [individuals] with cardiomyopathies or previously repaired or palliated congenital heart disease and heart failure associated with significant growth failure attributed to heart disease, pediatric heart disease with associated near sudden death and/or life-threatening arrhythmias untreatable with medications or an implantable defibrillator, or in pediatric restrictive cardiomyopathy disease associated with reactive pulmonary hypertension;
- The guidelines state that heart transplantation is feasible in the presence of other indications for heart transplantation, “in [individuals] with pediatric heart disease and an elevated pulmonary vascular resistance index >6 Woods units/m2and/or a transpulmonary pressure gradient >15 mm Hg if administration of inotropic support or pulmonary vasodilators can decrease pulmonary vascular resistance to <6 Woods units/m2or the transpulmonary gradient to <15 mm Hg.”
European Society of Cardiology-2016
The European Society of Cardiology (2016) guidelines on the diagnosis and treatment of acute and chronic heart failure recommended considering heart transplantation for [individuals] with end-stage heart failure with severe symptoms, poor prognosis, and no alternative treatment options.Active infection, severe peripheral arterial or cerebrovascular ischemia, pharmacologically irreversible pulmonary hypertension, cancer, renal insufficiency, systemic disease with multi-organ involvement, pre-transplant body mass index greater than 35 kg/m2, current alcohol or drug abuse, and insufficient social support to achieve compliant care in the outpatient setting were considered relative contraindications for heart transplantation.