Table 2.

Contraindications for long-term LVAD therapy

1	INTERMACS 1 (Cardiogenic shock) despite IABP, temporary MCS and/or inotropics
2	Life expectancy <2 years due to extracardiac disease
3	Severe comorbidity/end organ failure – Severe renal failure (estimated GFR <30 ml/min/1.73 m2), unlikely to improve after LVAD implantation – Severe liver failure/cirrhosis or portal hypertension, unlikely to improve after LVAD implantation – Severe pulmonary disease (with a FEV1 <1 liter), or pulmonary disease resulting in an important component of symptomatology that could result in de absence of improvement of symptoms after LVAD implantation – Severe central/peripheral artery disease and/or abdominal aorta >5 cm (untreated) – Symptomatic cerebral pathology in the recent 6 months and/or severe disability after neurological event and/or carotid artery stenosis >80% that cannot be treated – Severe neuromuscular pathology, limiting exercise capacity and/or ventilation postoperatively – Increased bleeding risk (which will not improve after LVAD implantation) a. Persisting thrombocytopenia (<50,000 × 109/l) b. Active bleeding c. Severe coagulopathy otherwise – Cognitive or psychosocial factors a. (Beginning) dementia b. Depression, unlikely to improve after LVAD implantation
4	Severe right heart failure, with a high risk for the need for right ventricular assist device (despite in BTT, implanting a biventricular assist device may be considered)
5	Phenotype of heart failure, in which implantation of a LVAD is impossible/complex: – Hypertrophic cardiomyopathy (unless, in dilating phase) – Restrictive cardiomyopathy/endomyocardial fibrosis – Complex uncorrected congenital heart disease/valvular disease
6	Difficulties in ventilation in intubated patients
7	Severe cachexia (BMI <18.5 kg/m2), unlikely to be corrected
8	Morbid obesity (BMI >35 kg/m2), uncorrected
9	(Increased risk for) systemic infection
10	Severely calcified ascending aorta (where outflow cannula is inserted; consider inserting the outflow cannula at another location)
11	Intolerance to coumarin derivates and/or thrombocyte aggregation inhibitors
12	Non-compliance, substance abuse (drugs/alcohol/nicotin)
13	Absence of social network, severe language barrier

LVAD left ventricular assist device, IABP intra-aortic balloon pump, MCS mechanical circulatory support, GFR glomerular filtration rate, BTT bridge to translation, BMI body mass index