LVAD Versus Cardiac Transplantation: When to List? When to Implant?

One of the most complex and difficult decisions for a heart failure (HF) team to wrestle with is the timing of placing a left ventricular assist device (LVAD) versus waiting for a donor heart to be available. This chapter provides a guide to providers that would allow a personalized decision to this complex process. In a patient with advanced HF and severely limiting symptoms, in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) classes 3 or 4, implantation of an LVAD may significantly reduce symptoms and improve quality of life. LVADs have a number of advantages over heart transplantation. Although common listing criteria exist, each transplant program has its own unique approach to transplant decision-making and few criteria are universal. Both ventricular assist device and transplant put significant burden on families and caregivers, particularly early after surgery, with patients ideally having dedicated 24/7 care in the early postoperative period.