Foreword

Transplantation is a clinical reality since 50 years. Nowadays, it is a standard procedure for patients with end-stage organ failure. Heart transplantation is still the gold standard for the therapy of end-stage heart failure. No other surgical or medical procedure achieves the same good long-term survival rates and superior quality of life as cardiac transplantation. However, with the increasing organ shortages of the last decade, transplant numbers are decreasing in Germany and worldwide. With longer waiting times, the mortality of patients on the heart transplant waiting list is rising again.

Therefore new therapeutic strategies for the medical and surgical management of end-stage heart failure patients have been developed. Individual patient-oriented concepts have been introduced in medical and surgical therapy.

New drugs, such as calcium sensitizers, can be used to successfully bridge terminally ill patients for a certain time. With better perioperative management, surgical revascularization or valve surgery can be performed in patients with severely impaired left ventricular function. New pumps offering mechanical support have been designed and launched on the market.

Our center started its mechanical assist device program in February 1993 with the first Novacor implantation. In the last 16 years, 11 different devices have been used in our center ([Fig. 1]). With 263 cardiac assist device implantations during the last 16 years, our center has specific experience in the field of mechanical support.

Fig. 1  Different mechanical assist device systems used in our center at different time periods.

Due to the prolonged waiting time of 2 to 3 years for patients on the heart transplant waiting list, the numbers requiring mechanical bridging are increasing. Data from our center show that, while in the 1990s the rate of mechanical bridging was only 16 %, this has increased to 39 % since the year 2000. In the last two years the rate of heart transplantation with prior mechanical support has reached 73 %.

With the prolonged waiting times on the heart transplant waiting list and the increasing organ shortage, almost every organ offer is only allocated to the Eurotransplant high-urgency list and not to “normal” waiting-list patients at home. In the first years after implementation of the new high-urgency organ allocation in December 2000, 53 % of our heart transplantations could be performed in patients on the “normal” waiting list. From 2004 to 2007, only 24 % of this “normal” waiting-list population had a chance of receiving a heart. In the last two years this number was reduced to a mere 4 %! Nowadays, only the sickest heart failure population with inotropic support in the intensive care unit or with device complications have a chance of receiving an organ offer within a certain period of time.

In this symposium held at Muenster University Hospital we focused on these special patients on the heart transplant waiting list. With presentations on Eurotransplant organ allocation, the National Disease Management Guidelines for surgical therapy of end-stage heart failure, new medical therapy trends for heart failure patients, new partial support assist devices and new generations of centrifugal assist devices, we provide an up-to-date guideline on modern therapies for end-stage heart failure.

PD Dr. med. Stefan Klotz
PD Dr. rer. medic. Gaby Drees