Author + information
- Received October 15, 2019
- Revision received January 2, 2020
- Accepted January 7, 2020
- Published online March 23, 2020.
- Maya Guglin, MD, PhDa,∗ (, )@MGuglin,
- Mark J. Zucker, MDb,
- Barry A. Borlaug, MDc,
- Erin Breen, RNd,
- Joseph Cleveland, MDe,
- Maryl R. Johnson, MDf,
- Gurusher S. Panjrath, MDg,
- Jignesh K. Patel, MD, PhDh,
- Randall C. Starling, MD, MPHi,
- Biykem Bozkurt, MD, PhDj,
- on behalf of the ACC Heart Failure and Transplant Member Section and Leadership Council
- aIndiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
- bRutgers University–New Jersey Medical School, Newark, New Jersey
- cDepartment of Cardiovascular Medicine, Mayo Clinic and Foundation, Rochester, Minnesota
- dDepartment of Medicine/Cardiology, George Washington University School of Medicine and Health Sciences, Washington, DC
- eDepartment of Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado
- fUniversity of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- gDivision of Cardiology, Department of Medicine, George Washington University, Washington, DC
- hSmidt Cedars-Sinai Heart Institute, Los Angeles, California
- iSection of Heart Failure & Transplantation, Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio
- jMichael E. DeBakey VA Medical Center and Section of Cardiology, Winters Center for Heart Failure, Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas
- ↵∗Address for correspondence:
Dr. Maya Guglin, Division of Cardiovascular Medicine, Gill Heart & Vascular Institute, 800 Rose Street, Lexington, Kentucky 40536.
• Evaluation for transplantation or LVAD placement is an evolving process that needs to be transparent for referring providers.
• The evaluation process is structured to establish patient eligibility for transplantation or LVAD placement, rule out contraindications, and choose between transplant and durable support.
• Presence of low cardiac output syndrome is a main indication for transplantation or LVAD placement, with some exceptions.
• Timely referral is a key to good outcomes of transplantation and LVAD placement.
Timely referrals for transplantation and left ventricular assist device implantation play a key role in favorable outcomes in patients with advanced heart failure. Nonetheless, evaluation usually occurs at advanced heart failure centers and is obscured from referring physicians. The purposes of this review are to explain the decision-making process for candidacy for advanced therapies and to describe the potential impact of the new organ allocation algorithm on center decision making. The document first addresses the signs of advanced heart failure, specifically focusing on the importance of the syndrome of low cardiac output as a key feature of advanced heart failure, and then summarizes the evaluation as a 3-step process addressing the following questions: 1) Is transplantation or durable assist device placement indicated? 2) Are there contraindications to either intervention? 3) How can one choose between transplantation and left ventricular assist device implantation if advanced therapies are indicated and not contraindicated?
The views expressed in this paper by the American College of Cardiology’s Heart Failure and Transplant Member Section and Leadership Council do not necessarily reflect the views of the Journal of the American College of Cardiology or the American College of Cardiology.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 15, 2019.
- Revision received January 2, 2020.
- Accepted January 7, 2020.
- 2020 American College of Cardiology Foundation
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