Surgical Approaches for Heart Transplantation in Cardiomyopathy Patients: Current Trends

Heart transplantation (HT) remains the only therapeutic option that significantly improves long-term survival for patients with end-stage cardiomyopathy. However, clinical practice faces challenges including the shortage of donor organs, increased surgical risks, and limitations in long-term survival. Recent advancements in minimally invasive surgery, precision immunosuppression, xenotransplantation, and artificial heart technologies have substantially improved transplant safety and outcomes; however, a systematic integration of these innovations is lacking. This study reviews technological advancements and current trends in HT to optimize clinical decision-making and promote individualized treatment strategies. A systematic review of literature published between 2015 and 2025 was conducted using PubMed and Web of Science databases. The search focused on five key areas of HT: minimally invasive surgery, donor expansion, precision immunosuppression, xenotransplantation, and postoperative management. Literature screening and analysis were performed independently by two researchers to ensure the objectivity and accuracy of the findings. Minimally invasive techniques, including partial Maryland and robot-assisted surgery, have significantly reduced postoperative bleeding and complications in high-risk patients. Normothermic machine perfusion (NMP) has extended donor heart preservation up to 12 hours, improving marginal donor utilization. Genotype-guided immunosuppressive therapy and donor-derived cell-free DNA (dd-cfDNA) monitoring enhance the precision of immunosuppression management. CRISPR-Cas9-mediated xenotransplantation has enabled successful transplantation of genetically modified pig hearts into humans, with reported survival exceeding 60 days. Magnetic Resonance Imaging (MRI) T1/T2 mapping and implantable hemodynamic monitoring technologies also show promise for the non-invasive early detection of rejection. Technological innovations have greatly enhanced clinical outcomes in HT. However, further long-term data and standardized evidence are necessary. Future efforts should focus on standardizing techniques, translating immune tolerance strategies into clinical practice, and establishing safety frameworks for xenotransplantation.