Cardiac transplantation should be considered for end-stage dilated cardiomyopathy only after all conventional and experimental pharmacological treatments have failed.
What are the appropriate management strategies and therapeutic options for patients with end-stage dilated cardiomyopathy prior to and as alternatives to cardiac transplantation?
This review emphasizes exhausting all pharmacological therapies before referring patients with end-stage dilated cardiomyopathy for cardiac transplantation and highlights the need for alternative mechanical or biological cardiac replacement strategies.
Patients should be referred for cardiac transplantation only after all other means of management of congestive heart failure have been attempted and have been unsuccessful (table 3). An adequate therapeutic trial of conventional and experimental agents including beta blockade and vesnarinone should be completed and be shown to be unsuccessful before transplantation is considered in patients in NYHA class III. Prospective clinical trials need to be completed to define the role of newer therapeutic options. The scarcity of donor organs will probably preclude the use of cardiac transplantation in all patients who may benefit. Alternative methods of cardiac replacement (such as dynamic cardiomyoplasty, permanent implantable mechanical circulatory assistance, and xenografting) must be developed. These methods coupled with better pharmacological treatment will greatly improve the outcome of patients with dilated cardiomyopathy.
OʼConnell et al. (Thu,) conducted a review in End stage dilated cardiomyopathy. Cardiac transplantation and alternative cardiac replacement was evaluated. Cardiac transplantation should be considered for end-stage dilated cardiomyopathy only after all conventional and experimental pharmacological treatments have failed.