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Purpose <p>Sex disparities in left ventricular assist device (LVAD) therapy remain a significant challenge in advanced heart failure care. This review synthesizes evidence on differences in epidemiology, clinical presentation, anatomical suitability, complications, and long-term recovery to clarify why women remain underrepresented despite comparable survival with contemporary devices. </p> Recent Findings <p>Women constitute nearly half of the heart failure population but only 20–25% of LVAD implantations. They often present later with HF phenotypes marked by microvascular dysfunction, diastolic stiffness, smaller ventricular size, and reduced right-sided reserve, increasing perceived procedural risk. Although contemporary centrifugal-flow devices have eliminated sex-based survival differences, women experience higher rates of hemorrhagic stroke, pump thrombosis, rehospitalization, and psychosocial burden. Contributing factors include device–patient mismatch, differences in clinical presentation, and disparities in referral and timing of evaluation for advanced heart failure therapies. Emerging innovations, such as miniaturized pumps, sex-specific risk models, and improved hemodynamic assessment, aim to reduce these disparities.</p> Summary <p>Achieving equity will require adaptable device designs, sex-specific diagnostic thresholds, individualized perioperative management, and greater female representation in clinical research.</p>

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Sex Differences in LVAD Therapy: From Diagnosis to Destination

  • 期刊论文

  • 发表日期：

    2026年5月9日

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  • Jarrett Fowler,
  • Mahwash Kassi

摘要

Purpose

Sex disparities in left ventricular assist device (LVAD) therapy remain a significant challenge in advanced heart failure care. This review synthesizes evidence on differences in epidemiology, clinical presentation, anatomical suitability, complications, and long-term recovery to clarify why women remain underrepresented despite comparable survival with contemporary devices.

Recent Findings

Women constitute nearly half of the heart failure population but only 20–25% of LVAD implantations. They often present later with HF phenotypes marked by microvascular dysfunction, diastolic stiffness, smaller ventricular size, and reduced right-sided reserve, increasing perceived procedural risk. Although contemporary centrifugal-flow devices have eliminated sex-based survival differences, women experience higher rates of hemorrhagic stroke, pump thrombosis, rehospitalization, and psychosocial burden. Contributing factors include device–patient mismatch, differences in clinical presentation, and disparities in referral and timing of evaluation for advanced heart failure therapies. Emerging innovations, such as miniaturized pumps, sex-specific risk models, and improved hemodynamic assessment, aim to reduce these disparities.

Summary

Achieving equity will require adaptable device designs, sex-specific diagnostic thresholds, individualized perioperative management, and greater female representation in clinical research.