Heart Transplantation: Still Therapeutic Gold Standard for Patients with Advanced Heart Failure?

The number of heart transplantations (htx) in Germany is still decreasing whereas mechanical circulatory support with ventricular assist devices (VAD) gains in importance. Initially designed as a bridge to transplantation, nowadays assist devices are applied as "destination therapy" in approximately 50% of the patients. Despite significant improvements of the devices, serious complications still have to be considered. Neurologic events and "driveline"-infections represent the most common problems of VAD-patients. Particularly further improvements of immunosuppressive therapy improved patients' outcome with regard to mortality and morbidity after heart transplantation. 1-year-survival after htx is approximately 80%, 5-year-survival just about 70%. To further improve the results, the implementation of a "cardiac allocation score" shall replace the currently applied HU-system that ignores the presumed postoperative outcome. Nowadays many patients do not suffer from serious complications for more than 15 years after htx. Despite continuously enhanced ventricular assist devices, heart transplantation still has to be considered as gold standard of surgical therapy in patients with advanced heart failure.