LVAD Destination Therapy Considerations — EECC MCQ

Correct answer: B — LVAD as destination therapy (DT) is appropriate for transplant-ineligible patients with advanced HF — the HeartMate 3 (fully magnetically levitated centrifugal pump) has 2-year survival ~70-80%, significantly better than medical therapy; key considerations include RV function, bleeding risk, psychosocial readiness, and caregiver availability

LVAD as destination therapy (DT) for transplant-ineligible patients per ESC 2023 HF Guidelines: (1) HeartMate 3 (centrifugal, fully magnetically levitated — no mechanical bearings): 2-year survival ~75-80% (MOMENTUM 3 trial), significantly superior to medical therapy for advanced HF (REMATCH trial: LVAD 52% vs medical 25% 1-year survival — with older devices); (2) candidate selection: INTERMACS 2-4 (1 has higher mortality but may still benefit), adequate RV function (RV failure post-LVAD is the major predictor of poor outcome — RVAD may be needed), acceptable nutritional status, psychosocial readiness (patients must manage the device, driveline care, anticoagulation), caregiver availability (24/7 support needed initially); (3) prior sternotomy increases surgical complexity but is NOT a contraindication; (4) CKD may improve post-LVAD (improved cardiac output → improved renal perfusion); (5) complications: driveline infection (~15-20%/year), GI bleeding (~15%), stroke (~5-10%), pump thrombosis (~2% with HM3), RV failure.

Reference: ESC (2023): HF; MOMENTUM 3/REMATCH