Investigators from the Cleveland Clinic reported in a recent issue of the Journal of Cardiac Failurethat, of all the patients referred to their institution for heart transplantation, two thirds were found to have a different option.
Between 1995 and 2000, 1174 patients were referred to the Cleveland Clinic to be considered for heart transplantation. These patients were considered by their doctors to have end-stage heart failure, and transplantation was felt to be the only viable choice left to them. After an evaluation at the Cleveland Clinic, only about 1 of 3 were ultimately placed on the transplantation waiting list. Half the referred patients were found to be improved sufficiently, after more aggressive medical therapy, such that they no longer needed transplantation. The remaining 22% were treated with surgical therapy other than cardiac transplantation.
The non-transplant surgery in these patients included coronary bypass surgery, valve surgery, or surgery to reconstruct the left ventricle. Patients who received these non-transplant surgical procedures had a 3-year survival of 82% -the same as the patients placed on the transplant waiting list who actually received transplantation.
DrRich Comments:
Cardiac transplantation is effective for end-stage cardiac patients, but it is inherently and severely limited by the small number of donor hearts available (despite decades of major efforts at increasing the participation of potential organ donors.) However, transplant centers have learned to adapt to this limitation by their aggressive non-transplant management of patients referred to them. This report from the Cleveland Clinic is a testimony to just how advanced the treatment of "end-stage" heart failure has become.
The problem is that most cardiologists and cardiac surgeons are still not prepared to provide this sort of aggressive non-transplant cardiac management. To a large extent, it is only the big transplant centers who have become comfortable providing this sort of care. This is why, if I had heart failure that my doctor declared as nearing end-stage, I would want to be referred to one of these major cardiac centers, even if I were lukewarm about the idea of transplantation itself. Odds are 2 out of 3 that some form of therapy short of transplantation would be found for me, and I would take those odds.
