Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 75, Issue 12, Pages 1471-1487Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2020.01.034
Keywords
heart failure; heart transplantation; left ventricular assist device
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Timely referrals for transplantation and left ventricular assist device implantation play a key rote in favorable outcomes in patients with advanced heart failure. Nonetheless, evaluation usually occurs at advanced heart failure centers and is obscured from referring physicians. The purposes of this review are to explain the decision-making process for candidacy for advanced therapies and to describe the potential impact of the new organ allocation algorithm on center derision making. The document first addresses the signs of advanced heart failure, specifically focusing on the importance of the syndrome of low cardiac output as a key feature of advanced heart failure, and then summarizes the evaluation as a 3-step process addressing the following questions: 1) Is transplantation or durable assist device placement indicated? 2) Are there contraindications to either intervention? 3) How can one choose between transplantation and left ventricular assist device implantation if advanced therapies are indicated and not contraindicated? (C) 2020 by the American College of Cardiology Foundation.
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