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Updated: Jul 2, 2026
07:39
Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
Ethical challenges with the left ventricular assist device as a destination therapy
Aaron G Rizzieri1, Joseph L Verheijde, Mohamed Y Rady
1Department of Physical Medicine and Rehabilitation, Mayo Clinic Hospital, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, Arizona 85054, USA. arizzieri@asu.edu
Philosophy, Ethics, and Humanities in Medicine : PEHM
|August 13, 2008
Summary
Left ventricular assist devices (LVADs) offer extended survival for end-stage heart failure but pose ethical challenges. Informed consent for LVAD destination therapy requires palliative care, complication planning, and caregiver support.
Area of Science:
- Cardiology
- Medical Ethics
- Palliative Care
Background:
- Left ventricular assist devices (LVADs) were initially for bridging to transplantation.
- LVADs are now approved as destination therapy for heart failure patients ineligible for transplant.
- Destination therapy presents significant ethical, quality of life, and caregiver burden challenges.
Purpose of the Study:
- To examine the ethical considerations of LVADs as destination therapy.
- To propose prerequisites for informed consent for LVAD destination therapy.
- To highlight the need for palliative care integration and caregiver support.
Main Methods:
- Review of LVAD use as destination therapy based on REMATCH trial data.
- Analysis of ethical, social, financial, and quality of life implications.
- Development of recommendations for informed consent and care planning.
Main Results:
- LVADs prolong survival but can negatively impact quality of life due to complications.
- Caregivers face substantial physical and mental health burdens.
- Social and financial ramifications exist for patients and families.
Conclusions:
- Informed consent for LVAD destination therapy necessitates a multidisciplinary approach, including palliative care.
- Essential components include complication management, caregiver support, advance care planning, and financial planning.
- Future research should assess end-of-life care quality and caregiver burden in LVAD destination therapy.
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