7.1 Background
At the time of LT-MCS implantation, patients are usually in their mid-50s (EUROMACS: mean 51.7, median 55 years) [91] or older (International Society for Heart and Lung Transplantation Mechanically Assisted Circulatory Support Registry, second report: 72% at >50 years) [92]. The majority of candidates for LT-MCS are INTERMACS level 3 or less, meaning at least they are inotrope dependent. Advanced age and inotrope dependency are both associated with comorbidities. Therefore, a thorough preimplant examination is crucial to identify absolute contraindications for LT-MCS implantation such as surgical contraindications, severe coagulation and haematological disorders and irreversible multiorgan failure. Moreover, life-limiting comorbidities and the chance of improvement after LT-MCS implantation can be assessed.