When is heart transplantation indicated in the treatment of dilated cardiomyopathy?

Updated: Mar 02, 2021
  • Author: Vinh Q Nguyen, MD, FACC; Chief Editor: Gyanendra K Sharma, MD, FACC, FASE  more...
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When progressive end-stage heart failure occurs despite maximal medical therapy, when the prognosis is poor, and when there is no viable therapeutic alternative, the criterion standard for therapy has been heart transplantation. Absolute indications for heart transplantation are as follows:

  • Refractory cardiogenic shock

  • Dependence on intravenous inotropes for organ perfusion

  • Peak oxygen consumption (VO2) less than 1 mL/kg/min with achievement of anaerobic threshold

  • Severe ischemia not amenable to any intervention

  • Symptomatic ventricular arrhythmias refractory to all therapies

Relative indications are as follows:

  • Peak VO2 of 11-14 mL/kg/min (or < 50-55% predicted for age and sex) and major limitation of daily activity

  • Recurrent instability of chronic heart failure not due to noncompliance or suboptimal medical therapy

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