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J Thorac Cardiovasc Surg 2004;127:1253-1255
© 2004 The American Association for Thoracic Surgery

Editorial

Transplant and ventricular assist devices: Gender differences in application and implementation

^a University of Minnesota Medical School, Division of Cardiovascular Surgery, Minneapolis, MinnUSA

Received for publication February 12, 2004; accepted for publication February 26, 2004.

^* Address for reprints: Sara J. Shumway, MD, University of Minnesota, Division of Cardiovascular and Thoracic Surgery, 420 Delaware St SE, MMC 207, Minneapolis, MN 55455, USA
shumw001@umn.edu

The first 20% of the full text of this article appears below.

See related editorials on pages 1245 and 1247.

 

Heart failure has reached epidemic proportions over the last several years. It may be no small coincidence that the incidence of obesity is also on the rise. Women tend to have a higher prevalence of heart failure over age 75. This may contribute to their relative underrepresentation as heart transplant and ventricular assist device (VAD) recipients. Total body surface area is also an issue with respect to certain VADs.

The most recent registry report of the International Society for Heart and Lung Transplantation (ISHLT) revealed that only 34.1% of donors were female.¹ The female heart donor in a female heart recipient may be responsible for an increased risk of interstitial myocardial fibrosis. As heart transplant recipients, women need a donor within 30% of their weight. A larger donor is indicated for the recipient with high pulmonary vascular resistance. Female recipients of cardiac transplantation have been reported to have an increased mortality when compared with male recipients.² Various immunologically related conditions, such as systemic lupus erythematosus and rheumatoid arthritis, are found in increased prevalence among women. Further, there is experimental evidence to suggest that fundamental immune responses, such as antibody production and rejection of allogeneic grafts, are potentiated in females. Thus, it is not surprising that studies have shown that female cardiac allograft recipients have a higher risk of cardiac rejection and the subsequent need for increased immunosuppression.³ How this affects survival in female patients remains to be seen. However, it certainly suggests that an earlier diagnosis and management of alloreactivity in female recipients before the development of acute rejection and the use of more focused and less global immunosuppressive therapy may significantly affect the outcome of female cardiac allograft . . . [Full Text of this Article]

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				N. C. Dang, V. K. Topkara, B. T. Kim, M. L. Mercando, J. Kay, and Y. Naka Clinical outcomes in patients with chronic congestive heart failure who undergo left ventricular assist device implantation J. Thorac. Cardiovasc. Surg., November 1, 2005; 130(5): 1302 - 1309. [Abstract] [Full Text] [PDF]