title: [Treatment of advanced heart failure in women: heart transplantation and ventricular assist devices].
abstract: Women candidates for heart transplantation are definitely less than men, just 20% of all patients transplanted; even in the INTERMACS registry they represent only 21% of all ventricular assist devices (VAD) implanted. The reasons for this big difference are discussed in this article. Why women are less frequently assessed for unconventional therapies? Are they sicker or just less regarded? Our experience and the literature show us clear epidemiological, clinical and treatment differences that could lead to a lower prevalence of end-stage disease in women of an age suitable for unconventional therapies. Once on the transplant list, women wait less than men for a heart transplant, because they present with more severe disease, have a lower body mass index and undergo less VAD implants. After transplantation women's survival is comparable to men's, although they usually complain of a lower quality of life. Females receive less often a VAD than men. The main reasons for this include presentation with advanced heart failure at an older age than men, worse outcomes related to small body surface area, and lower survival rates on VAD when implanted as bridge to heart transplantation.
authors.affiliation: Cardiologia 2 - Insufficienza Cardiaca e Trapianto, A. De Gasperis, A.O. Ospedale Niguarda Ca' Granda, Milano. manlio.cipriani@ospedaleniguarda.it
authors.forename: Manlio
authors.initials: M
authors.lastname: Cipriani
authors.forename: Francesca
authors.initials: F
authors.lastname: Macera
authors.forename: Alessandro
authors.initials: A
authors.lastname: Verde
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bruschi
authors.forename: Marta
authors.initials: M
authors.lastname: del Medico
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Oliva
authors.forename: Luigi
authors.initials: L
authors.lastname: Martinelli
authors.forename: Maria
authors.initials: M
authors.lastname: Frigerio
mesh_terms: D005260:Female; D006333:Heart Failure / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D012720:Severity of Illness Index