Eligibility criteria for mechanical support as destination therapy includes all of the following EXCEPT:
Current eligibility criteria for mechanical support as destination therapy include:
Once a patient has a left ventricular assist device inserted as destination therapy, close and intensive follow-up by a multidisciplinary heart failure team is required in order to optimize medical therapy, reduce device-related morbidity, and improve survival.
Angiosarcomas:
Primary cardiac malignancies are very rare, but when they occur they tend to have a right -sided predominance and frequently demonstrate extracardiac extension and involvement. Malignant cardiac tumors include angiosarcoma, osteosarcoma, leiomyosarcoma, rhabdomyosarcoma, liposarcoma, and primary cardiac lymphomas. Angiosarcomas are aggressive, rapidly invading adjacent structures, and 47 to 89% of patients present with lung, liver, or brain metastases by the time of diagnosis. Leiomyosarcomas are sessile masses with a mucous appearance that are typically found in the posterior wall of the left atrium. Rhabdomyosarcomas are bulky (> 10 em in diameter) tumors that usually occur in children and do not have a predilection for any particular chamber. They frequently invade nearby cardiac structures and are multicentric in 60% of cases.
Age-related calcific AS causes some degree of AI in approximately:
There are also many primary valvular diseases that cause AI, generally in association with AS. One such disorder is agerelated calcific AS, which causes some degree of AI in up to 75% of patients. Infective endocarditis may involve the aortic valve apparatus and cause AI through direct destruction of the valve leaflets, perforation of a leaflet, or formation of vegetations that interfere with proper coaptation of the valve cusps. Rheumatic disease causes fibrous infiltration of the valve cusps and subsequent retraction of the valve leaflets, inhibiting apposition of the cusps during diastole and producing a central regurgitant jet. Patients with large ventricular septal defects or membranous subaortic stenosis may develop progressive AI, owing to a Venturi effect that results in prolapse of the aortic valve leaflets.