Ventricular Assist Device (VAD) Patient Selection Criteria
UW Health is one of the national leaders in outcomes using left ventricular assist devices for patients with end-stage heart failure. Our team uses a broad spectrum of left ventricular assist devices (LVAD), tailoring selection to meet each patient's individual needs.
Candidates for LVAD as a bridge-to-transplantation include heart-failure patients who are listed for heart transplantation but may require the placement of a LVAD based on the following indications:
Destination Therapy Candidates
- Severe symptomatic heart failure despite optimal medical therapy, especially if the patient's body size and blood type suggest that the wait for a donor organ will be prolonged. Generally such patients will have a cardiac index of less than two, a pulmonary capillary wedge pressure greater than 20 or be inotrope dependent; however, each case is judged individually.
- Severe left ventricular dysfunction and intractable arrhythmias.
- Advanced heart failure complicated by cardiac cachexia.
- Advanced heart failure complicated by renal or hepatic dysfunction that is felt to be secondary to poor perfusion and/or congestion.
- Severe left ventricular dysfunction complicated by elevated pulmonary pressures not responsive to conventional agents or when these agents cannot be used or optimized due to low CO and systemic hypotension.
- Intractable angina not responsive to medical therapy or revascularization procedures in patients with poor left ventricular function.
- Post-cardiotomy shock.
Candidates for LVAD as destination therapy might require the placement of an LVAD as destination therapy based on the following indications:
- Severe symptomatic heart failure despite optimal medical therapy in a patient who is not felt to be a candidate for heart transplantation.
- Left Ventricular Ejection Fraction (LVEF) that is less than or equal to 25 percent.
- Exercise VO2 that is less than or equal to 12 ml/kg/min or need for continuous intravenous inotropes or IABP therapy to prevent symptomatic hypotension, decreasing renal function or worsening pulmonary congestion.