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When is ejection fraction (EF) low enough to consider heart transplantation?

I have what they say is severe cardiomyopathy. My last ejection fractions (EF) were between 20-25, which fell in a 2 year period from 30-35. I do have an ICD pump. When is it (EF) low enough to start talking about heart transplant, and should I be on a list?   

submitted by Katherine from Florida on 3/17/2011


by Texas Heart Institute cardiovascular surgeon, William E. Cohn, MD  

William E. Cohn, MDHi Katherine. I'm sorry to hear about your heart difficulties. From what you describe, your heart function has deteriorated significantly in the last 2 years, which is worrisome.

Whether or not you should be considered for a heart transplant, however, is a complex question that would require a thorough evaluation of you, and an intimate knowledge of your medical history. Without meeting you in person, it is impossible to answer that question. Some generalizations I can make may be helpful however.

Generally, heart transplantation is only considered once patients become very symptomatic. If you become very fatigued and short-winded after walking a short distance, despite strict adherence to a well thought out medical therapy and abstinence from salt, cigarettes, and other harmful substances, perhaps transplant should be considered. Heart transplants are frequently reserved for patients that are relatively young (under 65 years of age) and otherwise fairly healthy. The presence of other illnesses, like kidney failure, emphysema, or liver failure can make transplant more challenging.

That notwithstanding, some of the larger centers in the country will perform heart transplantation even in the presence of other illnesses. It is also important to know that there are other new therapies that have proven very effective in patients with heart failure and severe symptoms. One example is the new wave of small mechanical pumps that are implanted inside the body that assist the weakened heart.

The best advice that I can give you is to make sure you are seen regularly by a cardiologist who is very knowledgeable in the management of heart failure, and that is familiar with the significant advances made over the last 2-3 years. Good luck Katherine!    

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Updated March 2011
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