High INTERMACS Profiles: Medical Versus MCS Treatment

Abstract

Therapy with a left ventricular assist device (LVAD) is an established treatment for patients with advanced heart failure (HF). Past clinical trials evaluating LVADs for bridge to transplant and destination therapy (DT) were designed to assess safety and effectiveness in patients with the most advanced stage of HF. The guidelines today recommend consideration of LVAD support when patients have progressed to stage D heart failure, the point at which therapeutic options have been exhausted and the projected benefits in quality of life and survival outweigh the risks [1]. Consequently, the majority of LVAD implantations are performed in patients who are hospitalized and dependent on intravenous inotropic support. It has to be reminded that the initiation of inotropic therapy and its continuation are subjective clinical decisions and, therefore, the somewhat arbitrary decision of whether or not to initiate inotropic therapy; thus it does not necessarily identify a sicker population of patients. Anyhow INTERMACS classes IV–VII are expected to be a less sick population and consequently at a lower heart failure life-threatening risk. By definition these are stage D heart failure patients, NYHA classes III–IV, thus highly symptomatic for heart failure but not yet dependent on inotropic drug to preserve end-organ function.