Heart transplantation remains the most effective treatment for patients with end-stage heart failure. Over the past decade, significant advancements have been made in the field of heart transplant surgery. However, the enormous demand from heart failure patients and the severe shortage of available donor hearts continue to be major obstacles to the widespread application of heart transplantation. With the development of donor heart recovery, preservation, and evaluation techniques, the use of extended criteria donors and donation after circulatory death has increased. These technological advancements have expanded the safe ischemic time and geographic range for donor heart procurement, significantly enlarging the donor pool and driving a rapid increase in heart transplant cases. Concurrently, many new techniques have emerged in heart transplant surgery and perioperative management, particularly the rapid advancements in mechanical circulatory support and artificial intelligence, which hold the potential to revolutionize the field. This article reviews and discusses the current status and major surgical advancements in adult heart transplantation in the United States, aiming to provide insights and stimulate ongoing exploration and innovation in this field.
ObjectiveTo provide a practical reference for optimizing pediatric heart transplantation protocols in China by summarizing the perioperative management and short-term outcomes of pediatric heart transplant recipients at our center. MethodsWe retrospectively analyzed the medical records of all pediatric heart transplant patients performed at the Heart Center of the Children's Hospital, Zhejiang University School of Medicine, between June 2023 and September 2025. Data on donor and recipient demographics, indications for transplantation, use of mechanical circulatory support (MCS) as a bridge to transplant, perioperative clinical parameters, postoperative complications, immunosuppressive regimens, and follow-up outcomes were collected and analyzed. ResultsA total of 12 pediatric patients were enrolled, including 5 females and 7 males, with a median age of 9.7 (7.0, 13.0) years, all diagnosed with cardiomyopathy. MCS was used as a bridge to transplant in 58.33% of patients, including extracorporeal membrane oxygenation in 41.67% and a left ventricular assist device in 16.67%. The median donor heart cold ischemic time was 355 (306, 376) minutes. The most common postoperative complications were acute kidney injury (58.3%) and infection (58.3%). One week postoperatively, the median left ventricular ejection fraction recovered to 67.2% (61.8%, 71.0%). At discharge, 10 patients were in New York Heart Association (NYHA) functional class Ⅰ and 2 patients were in class Ⅱ. Over a follow-up period of 1 to 27 months, all patients survived with good cardiac function. ConclusionOur single-center experience demonstrates satisfactory short-term survival and cardiac function recovery in pediatric heart transplantation. Key areas requiring optimization include strategies for MCS bridging, management of prolonged donor heart cold ischemic time, and individualization of immunosuppressive regimens. Future development of a multi-center registry and genomics-guided precise immunosuppression strategies holds the potential to further improve long-term outcomes.
Post-implantation early right heart failure (RHF) following left ventricular assist device (LVAD) placement is characterized by a high incidence and poor prognosis. Current risk stratification models primarily rely on hemodynamic, imaging, and organ function parameters obtained under resting conditions, but their external validation and generalizability are limited. In contrast, stress testing, which increases cardiac load through vasodilators or exercise, offers incremental value in predicting postoperative RHF. This review centers on a dual-state assessment (rest and stress), summarizing the strengths and limitations of indices such as the ratio of central venous pressure to pulmonary artery wedge pressure (CVP/PAWP) and the pulmonary artery pulsatility index (PAPi). It further compares established risk models like CRITT score and European Registry for Patients with Mechanical Circulatory Support (EUROMACS), demonstrating the augmented predictive power of pharmacological or exercise stress testing. A stratified strategy is proposed, involving initial screening with static parameters followed by confirmatory stress testing. Furthermore, an integrated approach of incorporating stress-derived parameters into these models is suggested. Finally, the paper advocates for prospective validation studies in the cohort of patients receiving domestically-produced LVAD, with the aim of establishing a systematic framework to guide perioperative decision-making and enhance individualized prediction.
Although heart transplantation remains to be the optimal treatment for advanced heart failure, its use has been largely limited due to shortage of available donor organs. Over the past two decades, left ventricular assist device (LVAD) has been significantly modified in size, durability and hemocompatibility. In addition to the bridge to transplantation, LVAD has become an attractive alternative to heart transplantation for end-stage heart failure as destination therapy for unsuitable candidates. Although the performance of LVAD has been improving greatly in recent years, there are still great challenges in the management of device complications and low quality of life after implantation. This review will summarize the types of LVAD, indications for implantation, postoperative management and adverse events.
Heart failure is a global problem that occurs in 38 million patients worldwide, and the number is dramatically increasing in elderly society. Meanwhile, heart dysfunction is also the most common disease among hospitalized patients more than 65 years, especially in high-income countries. Approximately, one million patients are hospitalized because of heart failure in the world every year. Drug therapy is currently the most popular treatment for heart failure in clinic, however, the effects are limited. Therefore, exploring novel treatment strategies gradually becomes a focus not only in basic but also in clinical research.