State-of-the-Art Advancements in Heart Transplantation

Dear Colleagues,

Heart failure (HF) is a major unmet public health need. No treatments are currently available to address the fundamental problem of the limited regeneration capacity of cardiomyocytes. To date, the use of mechanical circulatory support (MCS) systems and heart transplantation (HTx) are the only well-established life-saving treatment options for patients with end-stage heart failure.

To date, the paucity of donors and consequent scarcity of organs together with the increasing number of unstable patients requiring a heart transplantation represent the major limit to Htx widespread use. This has driven research into the direction of the development of short-/long-term ventricular mechanical-assist devices as bridge or destination therapy. Despite improvements in MCS and Htx long-term results, there are still important gaps in our knowledge and understanding that will have to be filled in the future. The long waiting lists time for HF patients with or without MCS increase the risk of organ failure due to malperfusion, kidney and liver failure, contraindicating Htx. In this field, significant progress has been made with the development of multiple organ transplantation to treat heart failure and organ complication. However, there is no uniformity on the selection criteria for multiple organ transplantation and surgical programs in this field are far to be standardized.

To face the scarcity of organs, the most recent improvement in Htx from heterotopic donors is vital, in addition to organ recovery/preservation in cases of grafts with reversible injuries that could be employed in Htx. However, the final aim is the development of total bioengineered hearts, tackling the issue of the availability of grafts.

In this Special Issue, we aim to report the state of the art in HTx, unveil the most recent advances in this field and discuss results of Htx in specific patients’ categories with previous uncorrected/corrected congenital heart diseases (CHD). Patients who underwent CHD repair or palliation in infancy or childhood can develop late myocardial dysfunction with elements of both systolic and diastolic failure. The mechanism of heart failure is often multifactorial, resulting in a challenging indication.

Prof. Dr. Claudio Muneretto
Dr. Lorenzo Di Bacco
Guest Editors

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• extracorporeal membrane oxigenation
• impella
• left ventricular assisted device
• paracoroporeal VAD
• organ recovery
• heart transplantation
• bioengineered heart
• multiple organ transplantation