The recognition of LVADs as destination therapy provides clinicians with a clear and proactive pathway for patients who are not candidates for transplantation.
Australia has entered a quiet but significant new chapter in the management of advanced heart failure. From 1 March 2026, the Medicare Benefits Schedule item MBS 38620 formally recognises left ventricular assist devices (LVADs) as destination therapy; a long-term treatment option for patients who are not eligible for heart transplantation.
Historically, the referral pathways in advanced heart failure have been defined by supply and demand of heart transplant donors.
While medical therapies have improved outcomes, and transplantation remains the gold standard for selected patients, the reality is that many individuals have found themselves with few viable options once these pathways are exhausted.
The recognition of LVADs as destination therapy begins to reshape that landscape.
LVADs are a remarkable piece of engineering: a surgically implanted, battery-powered pump that supports the failing left ventricle in delivering oxygenated blood throughout the body. By assuming much of the heart’s workload, it restores systemic perfusion and stabilises end-organ function.
The latest devices are now using full magnetic levitation for a pump action that is gentle on blood cells, maximising blood flow. This minimises the risk of complications, and reduces the antithrombotic agents required, making destination therapy a more manageable reality.
For patients left with a weakened left ventricle, this device offers the possibility of time, function, and renewed independence.
Bridging the transplant bottleneck
In Australia, heart failure affects approximately 144,000 adults, the majority of whom are over the age of 65. While heart transplantation offers transformative outcomes for a select few, it is inherently constrained by donor availability and strict eligibility criteria. At any given time, up to 100 Australians are on the transplant waiting list.
The reality is that many will not receive a suitable donor organ in time.
Heart failure and its eventual progression to advanced disease is refractory to medical management, and ultimately many patients deteriorate in this time. This imbalance between need and supply has long defined the limits of advanced heart failure care.
LVADs have played a critical role in providing a bridge to transplant candidacy, sustaining patients while they await a donor organ.
At centres like St Vincent’s, patients may remain supported by LVAD bridge therapy for 12-18 months. Indeed, around half of patients who ultimately undergo transplantation in Australia are supported by an LVAD beforehand.
Yet, the bridge model isn’t perfect. Time itself becomes a risk factor and may introduce new risks; advancing age, frailty, comorbidities. For others, a donor is simply not available in time. In these cases, waiting is no longer a viable strategy.
Destination therapy as a long-term pathway
The recognition of LVADs as destination therapy marks a shift: rather than serving as a temporary bridge, the device is able to sustain patients as a long-term treatment strategy.
The introduction of funding under the MBS provides clinicians with a clear and supported pathway to offer LVAD therapy to patients with refractory heart failure who are not transplant candidates. At St Vincent’s Hospital, we have already begun implementing this approach in carefully selected patients.
This pathway is particularly relevant for older patients, including those in their sixties and seventies who remain active but are not well suited to transplantation. For these individuals, destination therapy offers not only extended survival but meaningful improvements in quality of life. Patients who were previously limited by breathlessness and fatigue are often able to return to daily activities, spend time with family, and regain a degree of independence. For many, this represents a substantial improvement in both function and wellbeing.
Continued evolution of LVAD
LVAD technology, particularly new generation devices have become increasingly reliable, with some of our patients remaining on LVADs for as long as 14 years.
As with any major intervention, risks remain. Patients on LVADs are more likely to experience blood clots following implantation and are subsequently given anticoagulant therapies to prevent this, which in turn often causes residual bleeding. Thrombotic and bleeding complications are well recognised, requiring careful anticoagulation strategies.
However, recent studies have shown that fully magnetically levitated next generation pump technology, and simplified antithrombotic strategies at lower doses, can reduce this bleeding risk.
Equally important are the practical improvement that shape patients’ daily experience of LVAD. Patients are supported by rechargeable batteries that they can charge nightly, and typically last up to 17 hours. The device works on a dual battery system so the patient can carry a spare and rotate these throughout the day, allowing for mobility and independence.
Certain limitations in long-term LVAD therapy persist. This includes the restriction of the driveline. This external electrical cable connects the pump and the controller. Importantly, this does present a restriction from water-related activities including swimming. Thankfully the driveline does not affect daily showers, as we can apply a special dressing and cover the controller allowing patients to shower freely.
Patients with an LVAD can travel internationally, but they should inform airport security that they have a medical device implanted in their body, to ensure they can pass through security safely. However, the driveline is perhaps where we as clinicians would like to see practical innovation in future.
LVAD within a system of care
It’s important to emphasise that LVADs do not replace the foundations of heart failure management. As cardiologists, we have excellent guideline-directed medical therapy at our disposal. This remains the cornerstone of care and should be optimised first and foremost. Only when patients experience persistent symptoms, repeated hospitalisations, or intolerance to treatment should advanced therapies be considered. Patients should be carefully selected for LVAD on this basis.
Even within experienced centres, LVAD therapy is not delivered in isolation. Implantation is performed by highly specialised teams, and successful outcomes rely on collaboration between cardiologists, surgeons, specialist nurses, and allied health professionals to support patients through implantation and long-term follow up.
The recognition of LVADs as destination therapy formalises an option that has been evolving for some time. It provides clinicians with a clear and proactive pathway for patients who are not candidates for transplantation, moving beyond a model that relies solely on donor availability.
Professor Christopher Hayward, MBBS(Hons), MD, BMedSc, FRACP, FCSANZ, is a cardiologist and Director of the Mechanical and Circulatory Support research program at St Vincent’s Hospital. His key research interests include the haemodynamics of cardiac failure and advanced heart failure management, particularly the patient pump optimisation of LVADs.
