Patient Selection for Destination LVAD Therapy: Predicting Success in the Short and Long Term

In this review, we discuss risk assessment of advanced heart failure (HF) patients as a referral guide for advanced HF therapies, including left ventricular assist device (LVAD) support and cardiac transplant.

The frequency of LVAD implantation for the purpose of permanent "destination" therapy is growing and survival on LVAD support is now approximating 50% at 5 years. Ambulatory HF patients with HF functional limitations, end-organ dysfunction, inability to tolerate HF medications, frequent cardiac admissions, and ventricular dysrhythmias are at high risk for mortality with medical management alone. Simultaneously, LVAD survival is superior in patients implanted prior to the onset of cardiogenic shock and/or multisystem dysfunction. Early referral (< 7% annual predicted mortality) of patients with systolic heart failure to an advanced heart failure specialist is critical for achieving long-term survival.