Indications and contraindications for heart transplantation

The article was professionally consulted with Master, Doctor Do Nguyen Thuy Doan Trang - Cardiovascular Center - Vinmec Central Park International General Hospital.

A heart transplant is a surgery that replaces a diseased heart with a healthy heart. Heart transplant takes place in a certain sequence, requiring meticulousness and caution of doctors in the indications for heart transplant, surgery and post-transplant follow-up.

The main indications for heart transplantation in adult patients are non-ischemic cardiomyopathy (53%) and ischemic cardiomyopathy (38%). Other indications include: valvular disease (3%), reimplantation (3%) and other diseases (<1%).
According to ACC/AHA guidelines, absolute heart transplantation is indicated in the following cases:
Cardiogenic shock that is refractory to medical therapy requiring intra-aortic balloon counterpulsation or left ventricular assist device (LVAD); Cardiogenic shock requiring continuous intravenous inotropic therapy (Dobutamin, milrinone, etc.); peak VO2 (VO2max) less than 10 mL/kg/min; Recurrent left ventricular arrhythmias, high risk of death despite implantation of a defibrillator, antiarrhythmic drug therapy, or catheter ablation; Resistant angina that does not respond to medical or surgical treatment. Relative indications for heart transplantation:
VO2 max from 10 to 14 ml/kg/min (or less than 55% predicted) and very limited in daily activities; Uninterventionable recurrent myocardial ischemia; Fluid balance/kidney dysfunction is not due to patient noncompliance.

According to the ACC/AHA guidelines, absolute contraindications to heart transplantation include:
Progressive irreversible renal failure with Cr > 2 or creatinine clearance < 30-50 mL/min with no planned copper transplantation. time; Irreversible progressive liver disease with bilirubin > 2.5 mg/dL, transaminases more than 2 times normal, or cirrhosis on biopsy; Irreversible progressive lung parenchymal disease (FEV1 <1 L/min); Irreversible progressive pulmonary hypertension (pulmonary artery systolic pressure >60 mmHg, pulmonary vascular resistance >4–5 Wood units despite vasodilator use), risk of acute right ventricular failure soon after during transplantation due to high pulmonary vascular resistance; History of solid organ disease or hematologic malignancy within the past 5 years due to the possibility of recurrence. Relative contraindications for heart transplantation for adults and children include:
Severe peripheral vascular disease; Severe cerebrovascular disease; Severe osteoporosis; Severe obesity (BMI > 35 kg/m2) or severe wasting; Acute pulmonary embolism; Active infection (excluding LVAD-related infections); Advanced age (> 70 years old); Psychological instability (eg, PTSD); Current or recent substance use (within 6 months) (alcohol, cocaine, opioids, tobacco products, etc.); Diabetes with target organ damage; Lack of social support or sufficient resources for ongoing immunosuppressive therapy and regular medical monitoring. An allergy to human leukocyte antigen (HLA) antibodies can cause a specific problem and may also prevent transplant eligibility. Must know the subjects that need to be assigned a heart transplant as well as the contraindications. Since then, promptly provide appropriate treatment for patients with severe heart failure, end-stage heart failure to help patients recover quickly.

Vinmec International General Hospital is a high-quality medical facility in Vietnam with a team of highly qualified medical professionals, well-trained, domestic and foreign, and experienced.
A system of modern and advanced medical equipment, possessing many of the best machines in the world, helping to detect many difficult and dangerous diseases in a short time, supporting the diagnosis and treatment of doctors the most effective. The hospital space is designed according to 5-star hotel standards, giving patients comfort, friendliness and peace of mind.