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Table 19. Indications and Contraindications to Durable
Mechanical Support
Indications (combination of these):
• Frequent hospitalizations for HF
• NYHA class IIIb to IV functional limitations despite maximal therapy
• Intolerance of neurohormonal antagonists
• Increasing diuretic requirement
• Symptomatic despite CRT
• Inotrope dependence
• Low peak VO
2
(<14–16)
• End-organ dysfunction attributable to low cardiac output
Contraindications:
Absolute
• Irreversible hepatic disease
• Irreversible renal disease
• Irreversible neurological disease
• Medical nonadherence
• Severe psychosocial limitations
Relative
• Age >80 y for destination therapy
• Obesity or malnutrition
• Musculoskeletal disease that impairs rehabilitation
• Active systemic infection or prolonged intubation
• Untreated malignancy
• Severe PVD
• Active substance abuse
• Impaired cognitive function
• Unmanaged psychiatric disorder
• Lack of social support
