Recommendation   Class   Level   References
It is recommended that reversible causes of heart failure are ruled out.  I  B
LT-MCS implantation should be considered in patients with the following: New York Heart Association functional class IIIB–IV and
Ejection fraction ≤25% and
At least one of the following criteria:     ○ INTERMACS 2–4
    ○ Inotrope dependence
    ○ Progressive end-organ dysfunction
    ○ Peak VO2 <12 ml/kg/min
    ○ Temporary MCS dependence  IIa  B
LT-MCS implantation may be considered in patients with: New York Heart Association functional class IIIB–IV and
Ejection fraction ≤25% and
    ○ To reverse elevated pulmonary vascular resistance or potentially reversible renal failure in potential heart transplant candidates
    ○ To allow time for transplant contraindications to be reversed such as recent cancer, obesity and recovering drug and alcohol dependence in potential heart transplant candidates  IIb  B
Patient characteristics associated with a high risk of poor outcome post-left ventricular assist device
LT-MCS in patients with advanced age, after careful evaluation of comorbidities and frailty, should be considered.  IIa  C  [3, 22–25]
LT-MCS in patients with peripheral vascular disease, depending on its severity, may be considered.  IIb  C
LT-MCS in patients with active systemic bacterial/fungal infection is not recommended.  III  B  [26, 27]
In patients with well controlled HIV, hepatitis B or hepatitis C, LT-MCS should be considered.  IIa  B  [26, 27]
In patients with diabetes with poor glycaemic control or end-organ complications, LT-MCS may still be considered.  IIb  B  [22, 28–30]
LT-MCS may be considered in patients with chronic dialysis.  IIb  C  [31–34]
LT-MCS implantation in patients with haemostatic deficiencies and coagulopathies may be considered.  IIb  B  [35–38]
LT-MCS implantation in patients with untreated aortic regurgitation or mechanical aortic valve is not recommended.  III  C  [39, 40]
LT-MCS in patients with untreated severe mitral stenosis is not recommended.  III  C
LT-MCS implantation in patients with irreversible liver dysfunction, as diagnosed by liver enzyme laboratory tests and the Model of End-stage Liver Disease score, is generally not recommended.  III  B  [41]
In patients with poor neurological and cognitive function, LT-MCS implantation is not recommended.  III  B  [42, 43]
Frail patients and patients with limited mobility may, after careful evaluation, be considered for LT-MCS implantation.  IIb  B  [44–48]
LT-MCS in patients who are living alone or who are suffering from depression should, after careful evaluation, be considered.  IIa  C  [19, 49–53]
LT-MCS implantation in patients who suffer from dementia is not recommended.  III  C  [19, 49–53]
LT-MCS implantation in patients with active substance abuse, not willing to cease the abuse, is not recommended.  III  C
LT-MCS implantation in patients with malignancies may be considered if expected survival is >1 year.  IIb  C  [33]