End Stage Heart Failure – Transplantation or Lvad?

Heart failure is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill or eject blood. According to the data from the International Society for Heart and Lung Transplantation registry, the half-life of patient survival after heart transplantation has progressively improved from 8.9 years in 1982 to a projected half-life of approximately 11 years from 2002 to 2006. The peak VO2 (VO2max) is the most objective assessment of functional capacity in patients with heart failure, and may be the best predictor of when to list a patient for cardiac transplantation. Mechanical cardiac support devices may be implanted in patients, in whose cases all other pharmacological therapies (oral medications and intravenous inotropes) for severe heart failure, as well as non-pharmacological support with intraaortic balloon pump counterpulsation, have failed. Left ventricular assist device provide support of the left ventricular function, causing reverse ventricular remodeling and permanent improvement of left ventricular function. End stage heart failure is not an end of life, since heart transplantation, better medications and devices, including ventricular assist devices implantations, offer patients a better quality and an appreciable extension of life.