Heart transplantation: current outlook.

Over 40 years after the first successful heart transplant in humans, it remains the treatment of choice for a selected group of patients with advanced heart failure (HF), despite the considerable progress made in HF treatment. Improved medical therapy has doubled the life expectancy of patients with HF and left ventricular (LV) systolic dysfunction, while in some patients cardiac resynchronization therapy can improve functional class, reduce the frequency of hospitalizations and increase survival, and implantable cardioverter-defibrillators reduce sudden death and late mortality. A significant number of patients with coronary and/or valve disease are currently accepted for conventional cardiac surgery or ventricular volume reduction surgery, with good medium-term results. Successive advances in ventricular assist devices, now in their fourth generation, mean that from the clinical standpoint, there are a variety of options available, ranging from temporary support and a bridge to possible transplantation to permanent therapy. Although it is still the gold standard treatment for advanced HF, with expected survival of more than 10 years and improved functional capacity and quality of life, heart transplantation is reserved for a small group of patients, both because there are other therapeutic options for less advanced HF, and due to the inherent limitations of the technique. The pool of potential donors is relatively small,