CARDIAC TRANSPLANTATION, CARDIOMYOPLASTY OF ARTIFICIAL-HEART

This is a difficult question and the answer is uncertain. The authors review the state of the art of the three methods in 1993. Cardiac tran splantation seems to have attained its maturity. The annual number of transplant operations is stagnant and the results progress little. Fun ctional rehabilitation is excellent, the essential immunosuppression w hich has not changed in principle over the last 12 years, remains prej udicial. Cardiomyoplasty is an attractive concept with difficult surgi cal indications (Stage III, moderately dilated cardiomyopathy with goo d right ventricular function without arryhthmias, pulmonary hypertensi on or mitral regurgitation), a delayed efficacy, a hospital mortality comparable with that of transplantation and a similar survival rate. T he objective results ar not as good as the more subjective functional improvement. This limited experience (about 500 patients in 50 centers throughout the world, 70 % of whom are European) should be continued and evaluated in the centers which initiated it. The artificial heart is only a temporary though essential therapeutic option in certain ext remely urgent situations. It is a form of circulatory assistance, rang ing from the simple univentricular accessory pump to the univentricula r (Novacor) or biventricular (Jarvik) heart, in a rapidly evolving tec hnology with problems of energy sources, marketing, cost and also clin ical management which is often difficult especially with respect to co agulation. What do the next ten years hold in store for us ? A nex imm unosuppressor or the xenograft ? A more efficient cardiomyoplasty with more precise medications ? A totally implantable autonomous artificia l heart ? Can economic considerations accompany this development ? Thi s is undoubtedly the deepest source of concern for the future.