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and provide support until the patient’s trajectory clarifies, whether towards myocardial recovery, transition to durable MCS or heart transplantation, or a palliative pathway. The care of patients on temporary MCS is complex and requires specialized expertise, including predefined strategies for withdrawal of support when there is no meaningful neurological and cardiac recovery. Temporary MCS should be considered in patients with INTERMACS profiles 1 or 2 as a bridge to decision, bridge to recovery, or bridge to either durable MCS or urgent heart transplantation (Figure 18). 8.2.2.2 Durable mechanical circulatory support

Durable MCS is indicated to prolong life and improve QoL in selected patients when FMT, and GDIT are insufficient or when temporary MCS has not led to cardiac recovery or clinical improvement (Table 16).602,603 Left ventricular assist device is by far the most common and reliable type of durable MCS; however, in cases with biventricular failure or special anatomical situations, a total artificial heart or implantable biventricular assist device is occasionally used.582 Management of patients who are possible candidates for LVAD or heart transplantation is outlined in Figure 18.

Figure 17 INTERMACS classification. ADLs, activities of daily living; CPET, cardiopulmonary exercise testing; HF, heart failure; i.v., intravenous; MCS, mechanical circulatory support; NYHA, New York Heart Association. The INTERMACS classification supports risk stratification and guides the timing of durable MCS or heart transplantation in patients with advanced HF.593 Supplementary data online, Table S18 provides a definition for inotrope dependence. Downloaded from academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehag100/8766302 by guest on 31 August 2026