Cardiac transplantation and mechanical circulatory support at Cleveland Clinic.

The cardiac transplantation program at Cleveland Clinic has performed 1,627 adult orthotopic heart transplants, with a current 1-year survival of 96% and a 3-year survival of 82%. The change in the heart allocation system in 2006 has affected our Center by both reducing the number of transplants we perform annually and increasing the percentage of recipients on MCS at the time of transplant. Despite the increased utilization of left ventricular assist devices (LVADs) as a bridge to transplant, we continue to maintain excellent outcomes. The major clinical advances in LVAD technology have allowed us to expand this therapy to ineligible transplant patients, with outcomes that are continually improving. Nevertheless, the field of MCS as permanent therapy is still in its infancy. The number of patients who can benefit from this technology in the U.S. alone is in the thousands, but refinements in patient selection and management are needed to further advance this lifesaving therapy.