Ethical aspects at the end of life with a left ventricular assist device: Destination therapy (DT): the multidisciplinary, palliative approach in the Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen

The treatment of patients with terminal heart failure (HF) with a left ventricular assist device (LVAD) has been offered at the Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen (HDZ NRW) since 1989 to patients with end-stage HF as an alternative or to bridge the interval until a heart transplantation. Permanent VAD therapy for patients who do not qualify for heart transplantation has increased in the sense of destination therapy (DT). The LVAD therapy now enables an average survival of more than 50% after 5 years and leads to a measurable improvement in the quality of life (QoL). A holistic therapeutic approach is recommended and necessary in LVAD therapy. Adequate treatment of complications of VAD therapy and general comorbidities play an increasingly more important role in permanent mechanical circulatory support. The patient's treatment goals must be constantly updated so that the preoperative, perioperative and postoperative formulation of an individual living will is also essential. The literature search clearly shows that the number of advance directives and thus the written formulation of the patient's wishes in difficult situations is increasing but it is still insufficiently formulated in proportion to the general population. The HDZ NRW has established a holistic treatment pathway that also takes difficult situations at end of life situations into account. In this article, the main features of multidisciplinary and holistic LVAD therapy are outlined and explained and illustrated by a case study.