Assessment
Table 1. Current Recommendations for MCS
ACCF/AHA 2009 HF guidelines
Consideration of a left ventricular assist device (LVAD) as permanent therapy or DT is
reasonable in highly selected patients with refractory end-stage HF and an estimated 1-year
mortality >50% with medical therapy. (II-B)
HFSA comprehensive HF practice guidelines
Patients awaiting heart transplantation who have become refractory to all means of medical
circulatory support should be considered for an MCS device as a BTT. (B)
Permanent mechanical assistance with an implantable LVAD may be considered in highly
selected patients with severe HF refractory to conventional therapy who are not candidates for
heart transplantation, particularly those who cannot be weaned from intravenous inotropic
support at an experienced HF center. (B)
Patients with refractory HF and hemodynamic instability and/or compromised end-organ
function with relative contraindications to cardiac transplantation or permanent MCS expected
to improve with time or restoration of an improved hemodynamic profile should be considered
for urgent MCS as a bridge to decision. These patients should be referred to a center with
expertise in the management of patients with advanced HF. (C)
Canadian HF guidelines
MCS may be offered to selected individuals with end-stage HF who are inotrope dependent and
do not meet the traditional criteria for cardiac transplantation. (IIb-B)
ESC guidelines 2008/2010
Current indications for LVADs and artificial hearts include bridging to transplantation and
managing patients with acute, severe myocarditis. (IIa-C)
Although experience is limited, these devices may be considered for long-term use when no
definitive procedure is planned. (IIb-C)
LVAD may be considered as DT to reduce mortality. (IIa-B)
