Cardiac replacement therapy: Critical issues and future perspectives of heart transplantation and artificial heart

• Published in: Current problems in cardiology Vol. 50; no. 3; p. 102971
• Main Authors: Fumarulo, Isabella, Stefanini, Andrea, Masarone, Daniele, Burzotta, Francesco, Cameli, Matteo, Aspromonte, Nadia
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.03.2025
• Subjects: Heart failure; Heart Failure - surgery; Heart Failure - therapy; Heart transplantation; Heart Transplantation - methods; Heart Transplantation - trends; Heart, Artificial - trends; Heart-Assist Devices; Humans; Left ventricular assist device; Mechanical circulatory support; Total artificial heart; Heart failure; Left ventricular assist device; Heart transplantation; Mechanical circulatory support; Total artificial heart
• ISSN: 0146-2806; 1535-6280; 1535-6280
• DOI: 10.1016/j.cpcardiol.2024.102971

Diagnostic and therapeutic advances in the cardiovascular field have caused a progressive reduction in mortality from acute causes, with an ever-increasing chronicity of cardiovascular pathologies. In recent years, mechanical supports have played a fundamental role, allowing the patient to be stabilized in the most critical phase of acute heart failure (AHF) and acting as a “bridge” for definitive therapies. Heart transplantation (HTx) is the gold-standard treatment for end-stage HF, but it is burdened by a series of critical issues that limit its use, first of all the shortage of grafts. It also requires the patient to take immunosuppressive therapy for life, which exposes him to a greater risk of infectious and oncological diseases. For these reasons, in the last years, mechanical supports are increasingly used as “destination therapy”, alternatively to HTx. However, also mechanical supports are not free from critical issues that limit their use. In this review we aim to analyze critical issues and future perspectives of advanced HF therapies.