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Heart Transplant Indications and Benefits

Failed existing transplant Cardiogenic Shock** Circulatory failure secondary to ↓ CO Untreatable Arrythmias** Irregular heart rate or rhythm Ventricular Assist Devices (VAD) Used as bridge to transplant Failure of treatment with conventional heart failure therapies Cardiac transplant recommended Major systemic diseases, including cancer Assess surgical readiness and comorbidities with evaluation by cardiac surgeon & cardiologist Psychological Instability Active or recent substance abuse Bridge to transplant with inotropes or mechanical circulatory support devices (VAD, ECMO, IABP) Cardiac Transplant Surgery to replace dysfunctional heart with a functional donor heart **See corresponding Calgary Guide slide(s) Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Heart Transplant: Indications & Benefits Indications Kate Fougere Authors: Reviewers: Emily Kuervers Sergio F. Sharif Dr. Robert Miller* Severe cardiomyopathy Myocardial dysfunction * MD at time of publication Disease of the cardiac Pump Failure ↓ Stroke volume (SV), muscle (Dilated, ↓ Forward flow, ↓ cardiac output (CO), hypertrophic, restrictive backup into lungs ↓ blood pressure (BP) cardiomyopathies**) Acyanotic heart disease Normal concentration of oxygenated Hb ↓ Perfusion of organs with ↑ pulmonary congestion Congenital Heart Disease** Disruption of normal cardiac formation that is unsuccessfully treated with surgical repair Cyanotic heart disease ↑ Concentration of deoxygenated hemoglobin (Hb) Cyanosis (dusky, blue skin discoloration) Cardiac Allograph Vasculopathy (CAV) Diffuse concentric narrowing of coronary arteries Antibody mediated graft rejection & fibrosis Symptoms of heart failure ** Cardiovascular risk factors exacerbated by immunosuppressive drugs ↓ BP Reduced SV with no response to medical therapy Pump Failure ↓ Forward flow, backup into lungs ↓ Perfusion of organs ↓ Level of consciousness End organ damage Abnormal electrical activity does not respond to pharmacological agents, cardiac ablation or electrophysiological interventions (ICD) Refractory arrythmias (ventricular tachycardia, ventricular fibrillation) & subsequent cardiac death Device complications arise while awaiting transplantation Device infection Clotting or bleeding complications (stroke or hemorrhage) Abbreviations: • ICD - Implantable cardioverter defibrillators • ECMO- Extracorporeal membrane oxygenation • IABP - Intra-aortic balloon pump Low survival benefit from transplant ↓ Capacity to manage post transplant requirements Graft rejection ↑ Potential for relapse after transplant ↓ Symptoms of heart failure** Restoration of cardiac output & normalization of volume status ↑ Life expectancy ↑ Quality of life Published Nov 23, 2025 on www.thecalgaryguide.com