title: Destination therapy with left ventricular assist devices: patient selection and outcomes.
abstract: OBJECTIVE
  Destination therapy with a left ventricular assist device (LVAD) has the potential to effectively treat a large number of patients with advanced heart failure who are not eligible for heart transplantation. With the advent of continuous-flow LVADs, safe and effective long-term circulatory support is available for properly identified candidates.
  
  
  RESULTS
  The highest mortality following LVAD implant is observed in the sickest patients (INTERMACS profile 1); therefore, there is an increasing trend toward selecting patients with INTERMACS profiles 2-5. The less-ill patients will be studied in the planned REVIVE-IT trial. The Heart Failure Survival Score, Seattle Heart Failure Model, and Destination Therapy Risk Score may provide guidance for patient selection and preoperative optimization therapy, but these tools need to be updated for current LVAD technology. The current 1-year survival rate for patients supported for destination therapy with a continuous-flow LVAD is 74%, which represents an increase of 6% since the clinical trial was completed 2 years ago.
  
  
  CONCLUSIONS
  Substantial progress has been made concerning survival and quality of life since destination therapy was first introduced 10 years ago. Advances in patient selection, improved LVAD technology, and optimized treatment strategies provide much optimism for the treatment of more heart failure patients in the future.
authors: Division of Thoracic and Cardiovascular Surgery, University of Louisville, 201 Abraham Flexner Way, Louisville, KY 40202, USA. mark.slaughter@louisville.edu
authors: Mark S
authors: MS
authors: Slaughter
authors: Anna L
authors: AL
authors: Meyer
authors: Emma J
authors: EJ
authors: Birks
mesh_terms: D018450:Disease Progression; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006352:Heart Ventricles; D006353:Heart-Assist Devices; D006801:Humans; D018579:Patient Selection; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States