Heart transplants remain the gold-standard treatment for the most severe heart failure, but the number of available donor organs is still far too small, according to Prof. Mariusz Kuśmierczyk, a cardiac surgeon and transplant specialist at the Medical University of Warsaw.
Kuśmierczyk said two technologies are moving fast enough to potentially challenge transplant medicine within five to 10 years: mechanical circulatory support, and xenotransplantation, meaning the transplantation of an organ from an animal, in this case a genetically modified pig.
Xenotransplantation is still in its early days.
Kuśmierczyk said that pig-heart transplants in humans have been performed for only around four years. In the United States, two such procedures have been carried out so far, with the first patient surviving about two months and the second about two weeks.
Better outcomes, he said, have been reported in patients who received pig kidneys.
He described mechanical devices as more promising in the near term, pointing to left ventricular assist devices (LVADs), which support the heart’s main pumping chamber.
Kuśmierczyk said he has implanted the HeartMate 3 LVAD for a decade in patients with advanced heart failure dominated by left-ventricle weakness.
Until recently, such pumps were mainly used as a “bridge to transplant,” helping patients survive while they waited for a donor heart.
Kuśmierczyk said that since 2024 these devices have also been implanted in people who cannot receive a transplant, including patients with current or past cancer, or older patients, typically over 70.
Some patients live with an LVAD for several years, he said, often longer than they would with medication alone.
He added that quality of life can improve significantly, with many patients returning to everyday activities, including an active lifestyle.
While he stressed that transplants still offer the best outcomes overall, Kuśmierczyk said survival rates for patients with pumps are beginning to approach those seen after transplantation, particularly after the first two years.
One major hurdle remains the energy supply.
Kuśmierczyk said the need to regularly charge external batteries is a key limitation, unlike pacemakers, whose batteries can last many years.
He said a breakthrough would come if LVAD batteries could be charged through the skin, removing the need for external connections.
Research is underway on inductive charging for a battery implanted along with the pump in the chest, he said.
There have also been efforts to develop a fully implantable artificial heart, designed to replace the failing heart entirely.
Kuśmierczyk pointed to a case in Sydney, where a patient received a titanium artificial heart called BiVACOR in November 2024 and survived 100 days while waiting for a donor organ.
Such devices, he suggested, could offer a lifeline for patients who are waiting for a transplant or do not qualify for one.
BiVACOR is not the only total artificial heart under development or in use. Kuśmierczyk said that a device called Carmat, developed in France under the leadership of cardiac surgeon Prof. Alain Carpentier, has been used for more than a decade and received certification in December 2023.
In May 2024, Kuśmierczyk implanted a Carmat artificial heart in Poland for the first time. He said it was the 58th implantation worldwide at the time.
The device was used in a 37-year-old patient with severe failure of both ventricles and pulmonary hypertension, a condition of high blood pressure in the lungs’ arteries. Kuśmierczyk said these factors made the patient unsuitable for a heart transplant and for standard mechanical circulatory support.
Kuśmierczyk also referenced comments by Prof. Chris Hayward of Sydney’s Victor Chang Cardiac Research Institute, who said fully implantable artificial hearts could become an alternative within a decade, for patients waiting for a donor heart or those who cannot undergo transplantation.
(rt/gs)
Source: PAP, rynekzdrowia.pl