| Sumario: | The Norwegian National Council for Priority Setting in the Health Care recommended in 2008 that left ventricular assist device (LVAD) should be offered to patients only for a limited period of time, for example while awaiting heart transplantation. This recommendation may be reconsidered. We have assessed LVAD as destination therapy. In 2008, there was one randomized controlled trial (RCT) comparing first-generation LVAD with optimal medical treatment. A literature search performed in June 2013 provided an RCT from 2009 that compared second-generation LVAD with first-generation LVAD, a few recent prospective case series, registry data and two relevant international cost-effectiveness analyses. Our main conclusions are: 1. Compared with optimal medical therapy LVAD can provide extended life time and improved quality of life for selected patients with end-stage heart failure. The magnitude of the clinical effect is uncertain. 2. There are no studies comparing LVAD with heart transplantation. 3. The most common complications associated with LVAD are bleeding, infections, need for pump replacement, stroke and right ventricular heart failure. These complications are the major cause of death the first two years following pump insertion. 4. The costs of LVAD have been reduced since 2008, but they are still high. International cost-effectiveness analyses are associated with uncertainty. A Norwegian cost-effectiveness analysis has not been performed. 5. Both to offer and not to offer LVAD as destination therapy is ethically challenging.
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