Left ventricular assist devices (LVADs) improve longevity, as well as functional capacity and quality of life in patients with medically refractory heart failure.1–5 During the 6 years since the US Food and Drug Administration approval of the first commercially available continuous flow LVAD in 2008, the number of patients supported by these devices has grown exponentially. The most recent report from the Interagency Registry for Mechanically Assisted Circulatory Support recorded nearly 2500 North American LVAD implants in 2013 at >150 implanting centers.6 Approximately 40% of LVADs are implanted as an indefinite form of support (ie, destination therapy [DT]), and nearly half of patients are surviving >4 years.6 This combination of improved survival and evolving implant strategies has led to an increasing number of LVAD recipients being integrated into the community and we are observing the growth of an ambulatory LVAD population with a unique set of clinical needs. There are 2 predominant strategies of LVAD implantation. Patients who are not eligible for transplantation because of issues such as advanced age may be considered for an LVAD as DT, implying that they will live the rest of their lives with the LVAD. This is in contrast to patients who undergo LVAD implantation as a temporary support device, to support them while awaiting transplantation. This later strategy is defined as a bridge-to-transplantation, following which, the device will be explanted. Centers implanting LVADs without concomitant transplant programs (designated DT centers) have emerged to provide this therapy, averting the need for travel to more distant transplant centers. Such DT centers operate in conjunction with a VAD/transplant partner in the care of patients awaiting transplantation. Because LVAD implant centers are frequently remotely located from the patients that they serve, a model of shared-care has developed, whereby the continued care of …
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