Perioperative feasibility and post-discharge residual risk in borderline candidates undergoing durable left ventricular assist device implantation: A single-center case series

Introduction Some patients considered for durable left ventricular assist device (LVAD) implantation have borderline features or relative contraindication factors that may lead to deferral or reconsideration of implantation. The relationship between perioperative feasibility and post-discharge residual risk in such patients remains incompletely described. Methods We retrospectively reviewed borderline LVAD candidates selected from 30 consecutive adults undergoing durable LVAD implantation between October 2024 and September 2025. Patients were included when major preoperative decision concerns influenced implantation planning. Outcomes were successful implantation with survival to first discharge and post-discharge residual risk-related events. Results Eleven borderline candidates were included. Median age was 56 years (range, 38-73 years). All patients underwent LVAD implantation and survived to first discharge. Median follow-up duration was 13.0 months (range, 2.1–18.0 months). During follow-up, death occurred in 2 patients, ischemic stroke or intracranial hemorrhage in 4, and gastrointestinal bleeding in 1. Conclusions Borderline candidacy features did not preclude LVAD implantation or discharge after individualized perioperative handling. However, post-discharge residual risk, especially cerebrovascular vulnerability, anticoagulation exposure, and care-management limitations, remained clinically important. LVAD candidacy should be considered as a longitudinal care pathway rather than a perioperative decision alone.