Implantation of a left ventricular assist device for destination therapy in people ineligible for heart transplantation

Current evidence on the efficacy and safety of the implantation of a left ventricular assist device for destination therapy in people ineligible for heart transplantation is adequate to support the use of this procedure provided that normal arrangements are in place for clinical governance, consent and audit. For people who are eligible for heart transplantation, refer to NICE's interventional procedures guidance on short-term circulatory support with left ventricular assist devices as a bridge to cardiac transplantation or recovery.

Patient selection should be done by a multidisciplinary team that includes a cardiologist with a specialist interest in heart failure, a cardiothoracic surgeon and a cardiac anaesthetist (see section 1.3).

Implantation of left ventricular assist devices for destination therapy should be done by surgeons, anaesthetists and intensive care specialists with special training and regular practice in performing this procedure and caring for these patients. Subsequent care should be provided by a multidisciplinary team including staff with the expertise to deal with patients' medical and psychological management, and with the maintenance of their left ventricular assist devices.

The National Institute for Cardiovascular Outcomes Research runs the UK Central Cardiac Audit Database (UKCCAD) and clinicians should enter details on all patients who have a left ventricular assist device for destination therapy.