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Comment & Response
September 23, 2020

Redefining Left Ventricular Assist Device Indications and Strategies—Reply

Author Affiliations
  • 1Center for Advanced Heart Disease, Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
  • 2Montefiore Einstein Center for Heart and Vascular Care, New York, New York
JAMA Cardiol. 2021;6(1):120-121. doi:10.1001/jamacardio.2020.4323

In Reply We are delighted that our work has now opened a legitimate debate for abandonment of dichotomous regulatory-enforced categories of indications that require declaration of either a bridge to transplant therapy or destination therapy intention at the time of consideration of left ventricular assist device (LVAD) implantation.1 The opportunity for this discussion is heralded by improved clinical outcomes achieved by the fully magnetically levitated continuous-flow centrifugal pump, the HeartMate 3 (Abbott Laboratories), with outcomes now approaching those of heart transplant at 2 years.2 Mehmood argues that refinement of the strategies should be undertaken to also include the concept of myocardial recovery, while Pal and colleagues believe that abandonment of individual implant categories must await even better outcomes with LVADs and express concern that a unified indication may have unintended consequences.