The Role of Durable Left Ventricular Assist Devices in Advanced Heart Failure: Would My Patient Benefit?

Mechanical circulatory support improves survival and quality of life in selected patients with advanced heart failure. The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) clinical profile (profiles 1-7) is a classification system of patients with American Heart Association stage D and New York Heart Association functional class IIIb-IV heart failure. Most left ventricular assist devices (LVADs) are implanted in patients dependent on inotropes (INTERMACS 3) or whose condition is deteriorating with inotropic support (INTERMACS 2). Clinical features associated with increased LVAD perioperative mortality include advanced age, significant renal or hepatic dysfunction, and right ventricular failure. We review the benefits and commonly encountered problems with durable LVADs to assist clinicians in identifying appropriate candidates for device implantation.