Cardiac transplantation: A primer for front-line clinicians

The heart failure tsunami-like pandemic continues to compromise patients, families and health care providers and further challenging healthcare systems across the world [1]. There is an urgent need for unified education across the spectrum of front-line providers and advanced heart disease and transplant specialists revolving around the understanding of key pathophysiologic patterns leading to advanced heart failure so early referral can be achieved [2]. Referral centers should be prepared to re-challenge patients with optimal guideline based medical therapy and offer a mechanistic approach for reversible coronary, valvular, rhythm, vascular, pericardial or myocardial solution. If unable to achieve improvements in meaningful clinical endpoints such as functional capacity and reported quality of life a detailed evaluation for temporary or durable mechanical circulatory support and/or subsequent heart transplantation is required [3]. The following will provide an overview of the road to heart transplantation in the contemporary era, focusing on key aspects such as indications for referral and management considerations tailored to non-transplant front-line providers.