Long term mechanical circulatory support and cardiac transplantation

SYNOPSIS Congestive heart failure remains a clinical syndrome characterized by a vicious cycle leading to progressive circulatory failure and end-organ dysfunction in an ever-increasing number of patients. The long-term goal in the treatment of these victims of heart failure is the improvement of their quality of life. We have outlined the current cardiac replacement strategies for individuals who have failed current medical therapies and are otherwise appropriate candidates for further therapeutic interventions. These cardiac replacement strategies include mechanical circulatory support devices, which are implemented both as a bridge to transplantation as well as permanent or destination therapy. The concept of bridging end-stage heart failure patients to recovery with mechanical circulatory systems is also addressed. Finally, the current state of cardiac transplantation including patient selection, operative techniques, postoperative management, immunosuppression strategies, and the most current results of cardiac transplantation is reviewed.