Table 5. Indications and Contraindications to Durable
Mechanical Support
Indications– Combination of the following:
Frequent hospitalizations for heart failure
NYHA class IIIb–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
Diagnosis
