PMC:6537946 / 1994-5492 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/6537946","sourcedb":"PMC","sourceid":"6537946","source_url":"https://www.ncbi.nlm.nih.gov/pmc/6537946","text":"INTRODUCTION\nThe first epidemiological analysis by the Framingham Heart Study revealed that heart failure is a fundamental factor of cardiovascular health [1]. Heart failure is usually diagnosed in adolescents and adults: The cumulative influence of risk factors over a period of years means that the incidence of heart failure increases with age and is higher in men than in women (Fig. 1) [2]. Heart failure affects 1–2% of the whole population and has a lifetime risk at the age of 55 of 33% in men and 28% in women [3]. Arterial hypertension and coronary heart disease remain the 2 most common conditions predating its onset [4, 5]. Heart failure, especially due to ischaemic heart disease, has remained the leading cause of death worldwide for the last 15 years [6]. In light of rising life expectancy across the globe and the persistence of risk factors like arterial hypertension and coronary heart disease, the prevalence of heart failure is predicted to increase by 46% from 2012 to 2030 and will therefore remain a leading cause of death [7].\nFigure 1: Prevalence of heart failure by sex and age (National Health and Nutrition Examination Survey, 2011–2014)—adopted and modified from Ref. [2]. Surgical treatment of end-stage heart failure such as a heart transplant or implantation of mechanical circulatory support (MCS) is mainly performed in patients with severely impaired systolic ventricular function due to end-stage cardiomyopathies who remain symptomatic despite optimal guideline-recommended treatment [8]. International guidelines recommend a heart transplant in end-stage heart failure and in the absence of contraindications (Table 1) [9, 10]. A consensus statement of the International Society of Heart and Lung Transplantation regulates listing and management policies for potential cardiac transplant candidates and was last updated in 2016 [11].\nTable 1: Indications and contraindications for a heart transplanta\nIndications for a heart transplant End-stage heart failure, NYHA IV functional class with congestion\nLimited prognosis without further support\nLimited treatment options\nMotivated, well-informed patient\nMental stability\nCompliant\nAbsolute and relative contraindications for a heart transplant Severe peripheral arteriosclerosis/cerebrovascular disease\nActive infection\nMalignancy\nSeverely impaired renal function\nSevere systemic disorders, multiorgan failure\nSecondary disease with poor prognosis\nIntellectual impairment\nPharmacologically irreversible pulmonary hypertension (→ proof of candidacy for LVAD with re-evaluation of haemodynamics under unloaded left ventricular conditions)\nBMI before a heart transplant \u003e35 kg/m2\nPersistent drug abuse\na Adapted from Ref. [9].\nBMI: body mass index; LVAD: left ventricular assist device; NYHA: New York Heart Association. Total implantation numbers of MCS prior to a heart transplant constantly increased in the past decade [12]. Based on the scarcity of allografts and the recently published improved long-term performance of current left ventricular assist devices (LVADs) [13], people might believe that mechanical devices can replace conventional heart transplants to a great extent.\nOur goal is to outline the general management of heart failure, the therapeutic goal of which is to reduce morbidity and mortality. Furthermore, we clearly demonstrate why a heart transplant remains the gold standard in the treatment of end-stage heart failure despite widespread and emerging MCS achieved with the 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