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Indications of ACC/AHA for Cardiac Transplantation in Patient with Heart Failure

Purpose: To determine if a patient with heart failure is a candidate for cardiac transplantation.

Description

The American College of Cardiology (ACC) and the American Heart Association (AHA) developed criteria for identifying a patient with heart failure who is a candidate for cardiac transplantation. A patient who does not meet one or more of these criteria has an insufficient indication for transplantation.


 

Patient selection: presence of heart failure

Condition

Transplant

refractory cardiogenic shock

absolute indication

dependence on intravenous inotropic support to maintain adequate organ perfusion

absolute indication

peak VO2 <= 10 mL per kg per minute, with anaerobic metabolism

absolute indication

peak VO2 11-14 mL per kg per minute, with major restrictions on the activities of daily living

relative indication

severe symptoms of cardiac ischemia with major restrictions in activities of daily living, not amenable to coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI)

absolute indication

recurrent unstable ischemia/angina, not amenable to coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI)

relative indication

recurrent symptomatic ventricular arrhythmias refractory to all therapeutic modalities

absolute indication

recurrent instability of fluid balance and/or renal function not due to patient noncompliance with medical regimens

relative indication

 

where:

• Peak VO2 = maximal oxygen uptake in mL per kg per minute.

• Cardiac ischemia or angina amenable to coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI) should undergo those procedures.

• Problems with fluid balance or renal function related to noncompliance are better addressed by trying to improve compliance. A patient who is noncompliant with medical regimens is unlikely to make a good candidate for cardiac transplant.

 


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Specialty

Objective

ICD-10