Heart Failure & Heart Transplantation

 

The Heart Failure Unit at the Hadassah University Medical Center was established to provide the basis for the National Heart Transplant Program. Since then, it has developed into an active center that offers comprehensive medical care to heart failure patients. Patients receive coverage from a multidisciplinary team of expert physicians, nurses, dieticians and social workers.

Primarily, the program is based on an active out-patient clinic and a day-care facility that operate throughout the week. In addition, patients can be hospitalized in regular medical ward beds, monitored beds and in the intensive cardiac care unit, which is fully equipped for hemodynamic monitoring.

This infrastructure has proven to be excellent for treating patient symptoms, improving functional capacity and quality of life, prolonging survival and keeping them out of the hospital as much as possible.

Hadassah's active heart transplant program combined with fully equipped modern cardiology facilities, that include sophisticated echocardiography, interventional cardiology and electrophysiology laboratories, have made the unit into a leading tertiary center for patients with advanced heart failure.

Since its establishment, the Heart Failure Unit has evaluated and treated over 1,000 patients with moderate and severe heart failure. Many patients initially referred to the unit as candidates for a heart transplant, who are subsequently found not to need of transplantation or have contraindications for the procedure, prefer to remain in the program as regular heart failure patients.

Patients who deteriorate into true endstage heart failure and are otherwise free of contraindications are automatically listed for transplantation at the center. The sickest patients, those requiring inotropic or mechanical support (defined as status I patients by UNOS classification), are hospitalized until transplant. Due to the severe shortage of organ donors in Israel and the constantly increasing waiting time for transplant, the center recently introduced a mechanical "artificial heart" as a "bridge to transplantation". This left ventricular assist device (LVAD) can be implanted in critically ill patients to keep them alive until a donor heart becomes available.

Most patients live a full life after transplantation, regaining normal quality of life and physical capabilities, in parallel with normalization of their left ventricular ejection fraction (LVEF).

Since the program was initiated,120 patients have been followed in the center after heart transplantation. Ten percent of the patients were under the age of 21 at the time of transplantation. Hadassah's medium and long-term survival rates are comparable to those of the International Society for Heart and Lung Transplantation (ISHLT). Many of the patients are alive over ten years following transplantation; the longest living post-transplant patient Hadassah has followed, has survived over 17 years.