B.1. What are the indications for LVAD?
Answer:
Patients with advanced heart failure and New York Heart Association (NYHA) class 3 or 4 symptoms despite medical and resynchronization therapy optimization are candidates for LVAD. Current indications include severe symptomatic functional limitations, objective evidence of cardiac dysfunction, confirmation of functional impairment and worsening clinical picture with poor prognosis. The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) further classifies heart failure patients being considered for mechanical circulatory support (Figure 6.7). Implantable LVADs may be indicated for patients who have poor quality of life and medium-term prognosis. However, exclusion criteria include quickly reversible causes of heart failure, significant comorbidity, or other life-limiting illnesses.
Figure 6.7.: Categorization of Patients with Heart Failure and 1-Year and 2-Year Survival Following Lvad Implantation, Stratified by Intermacs Profile.
Categorization of patients with heart failure and 1-year and 2-year survival following LVAD implantation, stratified by INTERMACS profile.ACC/AHA, American College of Cardiology/American Heart Association; ESC, European Society of Cardiology; HF, heart failure; HFmEF, heart failure with mid-range ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; INTERMACS, Interagency Registry for Mechanically Assisted Circulatory Support; LVADs, continuous-flow left ventricular assist devices; NYHA, New York Heart Association. (From Goldstein DJ, Meyns B, Xie R, et al. Third annual report from the ISHLT mechanically assisted circulatory support registry: a comparison of centrifugal and axial continuous-flow left ventricular assist devices. J Heart Lung Transplant. 2019;38:352-363, with permission from Elsevier.)
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