Table 6. Indications and Contraindications to Durable
Mechanical Support
Indications
Frequent hospitalizations for HF
Intolerance to neurohormonal antagonists
NYHA IIIb–IV functional limitations despite optimal maximal therapy
End-organ dysfunction owing to low cardiac outputa
Increasing diuretic requirement
Cardiac resynchronization therapy (CRT) nonresponder
Inotrope dependence
Low peak Vȯ2 (<14 mL/kg/min)
Contraindications
Absolute
Irreversible hepatic disease
Irreversible renal disease
Irreversible neurological disease
Medical nonadherence
Severe psychosocial limitations
Relativeb
Age >80 y for DT
Obesity or malnutrition
Musculoskeletal disease that impairs rehabilitation
Active systemic infection or prolonged intubation
Untreated malignancy
Severe peripheral vascular disease
Active substance abuse
Impaired cognitive function
Unmanaged psychiatric disorder
Lack of social support
Cardiorenal syndrome, hepatic insufficiency, and pulmonary venous hypertension.
b
Relative contraindications warrant evaluation by advanced HF team.
a
