Which device is indicated when advanced heart failure is refractory to medical therapy and provides mechanical circulatory support?

• A. Cardiac resynchronization therapy
• B. Left ventricular assist device
• C. Implantable cardioverter-defibrillator
• D. Artificial heart

Answer: (B)

When heart failure no longer responds to medications, the goal is to provide actual mechanical support to maintain circulation. An implantable left ventricular assist device fits this need because it directly takes over part of the pumping work from the failing left ventricle. By drawing blood from the left ventricle (or left atrium) and delivering it to the aorta, it raises cardiac output and improves organ perfusion. This device can act as a bridge to heart transplantation or as durable, long-term therapy for patients who are not transplant candidates.

Other devices have different roles. A cardiac resynchronization therapy device improves the timing of contractions but does not provide continuous mechanical support. An implantable cardioverter-defibrillator reduces the risk of sudden death from arrhythmias, without aiding pumping. An artificial heart replaces both ventricles and is reserved for very limited, end-stage cases. The LVAD specifically addresses the need for mechanical circulatory support in advanced heart failure that remains refractory to medical treatment.