Heart transplants are now less common in transthyretin amyloid cardiomyopathy (ATTR-CM) than they used to be, thanks to advances in medical treatments that slow or even stop progression of the disease. However, they remain a viable option with positive outcomes in select cases of severe heart failure — but only on rare occasions. The recommended approach is now to manage heart failure symptoms through new therapies and lifestyle modifications.
The cardiovascular impact of ATTR-CM
In ATTR-CM, the liver produces faulty transthyretin (TTR) protein. This protein misfolds and creates clumps of amyloid fibrils that are deposited in the body’s connective tissue and organs. In the heart, the amyloid deposits cause the left ventricle to stiffen and thicken, inhibiting the pumping of oxygen-rich blood around the body. This leads to progressive heart failure (or cardiomyopathy), with symptoms such as fatigue, shortness of breath, swelling of the legs, feet and ankles, brain fog, coughing or wheezing, dizziness and an irregular heartbeat.
Read more about ATTR-CM signs and symptoms
Disadvantages of heart transplants in ATTR-CM
A heart transplant is an option for end-stage heart failure in a small number patients with ATTR-CM. Once a decision to proceed has been made, it may take months or even years to find a suitable donor.
A heart transplant is major surgery, and its eligibility criteria are strict. To successfully tolerate the high-risk surgery and life-long immunosuppressive medication required following the transplant, patients must be in good overall health with no other serious health conditions, be a nonsmoker and meet age requirements, among other criteria.
Possible complications of a heart transplant include infection, bleeding, side effects of the immunosuppressants and organ rejection. Recovery following a heart transplant can take several months.
Since the liver is the source of the problem in ATTR-CM, even if a heart transplant is successful, amyloid fibrils will continue to be deposited in the heart after the procedure. In cases of hereditary ATTR-CM, a liver transplant may also be considered to stop the production of amyloid fibrils.
Alternatives to a heart transplant
Effectively managing heart failure symptoms can significantly improve quality of life and overall survival in people living with ATTR-CM and cardiomyopathy. Symptom management includes:
Prescribed ATTR-CM medication: The right medication can slow or stop the disease from progressing. ATTR-CM medications work by stabilizing the TTR protein or by stopping the faulty proteins from producing and misfolding.
Prescribed heart failure medication: Your cardiologist will prescribe medications such as diuretics, beta-blockers or anticoagulants to help manage your heart failure symptoms.
A healthy, nutritious low-sodium diet: A balanced low-sodium diet will support the body’s functioning and reduce swelling.
Regular low-impact physical activity: Movement will increase blood flow, build cardiac strength and boost mood.
Close follow-up care from your healthcare team: Good medical support and care is critical to learning to effectively manage cardiovascular symptoms of ATTR-CM.
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