301 Ch 300. Cardiac Transplantation and Mechanical Circulatory Support

心臟移植 是 advanced HF 的 definitive 治療，現代 1 年存活 ~ 90%、5 年 ~ 75%、10 年 ~ 50%；indications：refractory HF NYHA III-IV despite optimal medical therapy + EF ≤ 25%、life-threatening arrhythmia、CHD with severe RV failure；contraindications：active malignancy、severe pulmonary HTN (fixed)、active substance abuse、untreated infection、severe comorbidities；MCS (mechanical circulatory support) 為 bridge to transplant、bridge to recovery、destination therapy；現代 LVAD (HeartMate 3) 為 magnetically levitated centrifugal flow pump，MOMENTUM 3 trial 改寫 LVAD survival；post-transplant: immunosuppression (calcineurin inhibitor + antiproliferative + steroid)、cardiac allograft vasculopathy (CAV) 是 long-term killer；heart-lung transplant 用於 PAH 與 Eisenmenger；xenotransplantation + iPS-derived cardiomyocytes 為 2024-2026 前沿；台灣 2023-2024 心臟移植年約 80-100 例，等候名單 > 200。