Heart transplantation: review

Abstract

Heart transplantation is currently the definitive gold standard surgical approach in the treatment of refractory heart failure. However, the shortage of donors limits the achievement of a greater number of heart transplants, in which the use of mechanical circulatory support devices is increasing. With well-established indications and contraindications, as well as diagnosis and treatment of rejection through defined protocols of immunosuppression, the outcomes of heart transplantation are very favorable. Among early complications that can impact survival are primary graft failure, right ventricular dysfunction, rejection, and infections, whereas late complications include cardiac allograft vasculopathy and neoplasms. Despite the difficulties for heart transplantation, in particular, the shortage of donors and high mortality while on the waiting list, in Brazil, there is a great potential for both increasing effective donors and using circulatory assist devices, which can positively impact the number and outcomes of heart transplants.

Effects of Physical Exercise in Patients After Cardiac Transplantation: A Systematic Review

“…Some variables can be used to predict the prognosis of patients undergoing this intervention, such as: oxygen consumption and the equivalent of ventilation of carbon dioxide. In addition, patients with chagasic cardiomyopathy have a worse outcome after surgery 3 .…”

Reactivation of Chagas disease in a heart transplant patient infected by sylvatic Trypanosoma cruzi discrete typing unit I

“…Subsequently, the amastigotes undergo transformation into metacyclic trypomastigote, which invade the circulation and colonize the tissues. This phenomenon has been variably reported, with results from zero to 50% of cases 1 .…”

“…Cardiac transplantation as an therapy for Chagas cardiomyopathy was initially controversial because the disease has an infectious etiology and systemic involvement, However, it is currently the only therapeutic option for patients in the final stage of cardiac failure 1 .…”

“…Despite the wide spectrum of manifestations, reactivation rarely causes death and the probability of survival in the short and medium terms are similar among transplanted patients with Chagas cardiomyopathy or idiopathic dilated cardiomyopathy 1 . This finding has been attributed to various factors of patients with Chagas disease, including low lung vascular reactivity, low incidence of acute failure of the graft, and sudden death compared with patients with dilated cardiomyopathy due to another etiology 5 .…”

“…Heart transplantation is the last therapeutic option for Chagas disease patients with severe cardiomyopathy. Nevertheless, the immunosuppressive treatment that accompanies transplantation increases the probability of infections, including the reactivation of Chagas disease 1 . T. cruzi has been divided into six discrete typing units (identified as TcI-TcVI), with a proposed seventh (TcBat) typing unit related to TcI.…”