skip to main content

LVAD Destination Therapy — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardCardiologyLVAD Destination TherapyRACP Adult Medicine

A 70-year-old man with advanced heart failure (LVEF 15%) and recurrent ICD shocks for VT/VF despite maximal medical therapy and VT ablation is being considered for advanced heart failure therapies. His INTERMACS profile is 3 (stable but inotrope dependent). He has significant comorbidities precluding transplant. What is the most appropriate long-term device therapy?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Cardiac resynchronisation therapy upgrade

For end-stage heart failure patients who are not transplant candidates (destination therapy), a durable LVAD (e.g., HeartMate 3) provides significant survival and quality-of-life improvement. The MOMENTUM 3 trial showed the HeartMate 3 had superior outcomes with reduced pump thrombosis. INTERMACS profile 3 (stable but inotrope-dependent) is an appropriate timing for LVAD implantation. Earlier implantation (INTERMACS 4–7) may also be considered. Complications include pump thrombosis, driveline infection, GI bleeding, and right heart failure.

Reference: NHF/CSANZ – 2022 – Heart Failure Consensus; ESC – 2023 – Heart Failure Guidelines