Heart Transplantation: Is It Still the Gold Standard?

Patients with advanced heart failure (AHF) have a poor prognosis. Significant advancements have been made in the surgical treatment of AHF with the use of mechanical circulatory support (MCS) and heart transplantation (HT). In carefully selected patients with AHF, HT remains the gold standard treatment, but left ventricular assist device (LVAD) therapy has become an important alternative. The 5-year survival post HT is 72% compared to 58-63% with contemporary LVADs. While HT provides a better quality of life and freedom from device-related complications, it is limited by the availability of donor organs. In the future, fully implantable LVAD systems and expanded donor strategies are expected to further optimise treatment options for patients with AHF.