Mechanical circulatory devices have long been considered a bridge to heart transplantation. But over the past year, UW Health has been placing more ventricular assist devices (VADs) in patients who are not candidates for heart transplant. The outcomes are promising and show that VAD as destination therapy can be a viable option for some patients with end-stage heart failure.
“At UW Health, we have adopted a more proactive and holistic approach,” said Dr. Veli Topkara, medical director of the UW Health Heart Failure, Cardiac Transplantation and Mechanical Circulatory Support Program. “The culture has shifted from asking, ‘Is this patient too high-risk?’ to ‘Can this therapy meaningfully improve survival and quality of life, and how can we safely make it work?’”
If a patient has a desire for the therapy, the team at UW Health works with them to make it happen. One example: A patient who was in cardiogenic shock wanted to try VAD as a destination therapy, but he lived by himself and did not have the outside support a patient would typically need. The program’s social workers and nurse coordinators worked with him to overcome the barriers that made it difficult for him to accept help from others.
“Some patients don’t have the perfect psychosocial support,” said Heather Jaeger, clinical manager of the heart failure and transplant program. “So, we work together to think about ways we can support patients who don’t have what we would previously have established as the ideal support.”
The data supports the program’s new approach. While UW Health physicians implanted only five adult VADs in 2024, they implanted 16 in 2025. And the post-implant survival rate is impeccable: there have been no deaths in that two-year timeframe.
“In 2025, one-quarter of the patients we implanted were over the age of 70,” said Dr. Topkara. “They were considered very high-risk, yet they’re doing well. This shows that the outcomes are good, even in older populations.”
On the flip side, Dr. Topkara said, the median survival of an advanced heart failure patient who has not received a VAD is about one year. “Median survival with a VAD is about six years, based on the data we have now,” he said. “If we can implant these devices safely, we are giving patients an average of five more years of life.”
This content is sourced from
UW Health
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