Few decisions are weightier than choosing between a heart transplant, an LVAD, or continued medical therapy for advanced heart failure. Are you truly a candidate? Is the timing right? Should it be a transplant or a pump — bridge or destination? An independent review by a cardiac surgeon and a cardiologist, with triple risk-model scoring (STS, EuroSCORE II, AATS), answers these questions with your real numbers. A written review is delivered within 24 hours of your records — from $500.
Cardiac surgeon + cardiologist review · From $500 · 24-hour written review after records · No referral · HSA/FSA eligible
A transplant or LVAD second opinion exists to answer four questions clearly and honestly. We address each one directly, in writing, signed by your Heart Team.
These are very different paths. A heart transplant replaces the failing heart with a donor organ; a left ventricular assist device (LVAD) is a mechanical pump that supports your own heart, either as a bridge to transplant or as permanent destination therapy. We review whether you are being directed toward the right option for your physiology, your other organs, and your goals of care.
Candidacy for transplant and durable LVAD hinges on a detailed workup: cardiac output and hemodynamics, kidney and liver function, pulmonary pressures, frailty, nutrition, and psychosocial support. We confirm whether the eligibility determination matches what your records actually show, and whether a barrier called irreversible may in fact be modifiable.
Advanced heart failure is a moving target. Listing or implanting too early exposes you to major risk before you need it; waiting too long can make you too sick to qualify. We assess where you sit on the trajectory and whether the proposed timing reflects current data on survival and quality of life.
Transplant and LVAD outcomes vary widely by program. Center volume, waitlist dynamics, and post-implant survival differ meaningfully between institutions. We identify the highest-volume, best-outcome programs for your specific situation rather than the nearest center alone.
Understanding what each path involves — and how eligibility and timing are actually judged — is the foundation of an informed decision. Here is what an independent Heart Team review examines.
Heart transplant offers the best long-term survival for eligible patients but is limited by donor supply, waitlist time, and lifelong immunosuppression. A durable LVAD can serve as a bridge to transplant while you wait, or as destination therapy for patients who are not transplant candidates. The right path depends on your candidacy, your urgency, and your own priorities. An independent review clarifies which option the evidence actually supports for you.
Eligibility is a comprehensive judgment, not a single number. Pulmonary hypertension, renal or hepatic dysfunction, prior sternotomy, obesity, diabetes, frailty, and social support all factor in. Some apparent contraindications are fixed; others are reversible with optimization. We examine whether each barrier in your case is truly disqualifying or whether a path back to candidacy exists.
INTERMACS profiles describe how sick a patient is, from stable on inotropes to crashing-and-burning. Where you fall changes everything about timing. We assess whether your trajectory supports referral, listing, or implant now, or whether continued medical optimization is the better next step before committing to a major operation.
For both transplant and LVAD, the program you reach is among the strongest predictors of your outcome. High-volume centers consistently achieve better post-transplant and post-implant survival, shorter waitlist mortality, and lower complication rates. We match your case to programs with the strongest documented results for your specific situation.
We calculate your operative and post-operative risk using validated cardiac surgery models — STS, EuroSCORE II, and AATS — together with a frailty assessment, so you have a concrete, personalized estimate of risk rather than a vague reassurance. For advanced heart failure, knowing your real numbers is essential to weighing transplant, LVAD, or continued medical therapy.
A transplant or LVAD evaluation lives or dies on the completeness of a handful of key studies. These are the records our Heart Team relies on most.
Your transthoracic and any transesophageal echo, with ejection fraction, chamber sizes, valve function, and right-heart assessment — the foundation of any advanced heart-failure evaluation.
Pulmonary artery pressures, pulmonary vascular resistance, cardiac output, and filling pressures are decisive for both transplant candidacy and LVAD suitability. Reversibility of pulmonary hypertension on vasodilator testing is especially important.
Coronary anatomy and any prior revascularization, which inform whether ischemic disease is contributing and whether other surgical options were considered first.
Renal and hepatic function, BNP/NT-proBNP, hematology, and metabolic labs that determine end-organ reserve and influence eligibility for transplant or durable mechanical support.
Cardiac CT or MRI where available, heart-failure clinic notes, prior surgical history, and any completed transplant or LVAD evaluation paperwork, so the review reflects the full clinical picture.
Your cardiac surgeon and cardiologist lead the review to evaluate every dimension of transplant, LVAD, and continued medical therapy.
We map your workup against current ISHLT and society criteria to confirm whether transplant or durable LVAD is genuinely indicated, and whether any cited contraindication is truly fixed or potentially reversible with optimization.
Systematic comparison of heart transplant, bridge-to-transplant LVAD, and destination-therapy LVAD for your specific physiology, end-organ function, urgency, and goals of care.
STS, EuroSCORE II, and AATS risk models calculated from your clinical data, with predicted operative mortality and major morbidity plus a frailty assessment that generic risk quotes often omit.
Independent review of your echocardiogram, right and left heart catheterization, labs, and imaging, checking that the workup is complete and that the proposed plan matches what the data actually show.
We identify transplant and LVAD programs with the highest volumes and best documented survival for your specific situation, so the recommendation includes not just the right therapy but the right program.
Begin wherever you feel most comfortable. Every path reaches the same Heart Team.
A heart transplant replaces your failing heart with a donor heart and offers the best long-term survival for eligible patients, but it depends on donor availability and requires lifelong immunosuppression. A left ventricular assist device (LVAD) is a surgically implanted mechanical pump that supports your own heart. An LVAD can be used as a bridge to transplant while you wait for an organ, or as destination therapy for patients who are not transplant candidates. Which path is right depends on your candidacy, urgency, end-organ function, and personal goals, and an independent review helps clarify that choice.
Candidacy is determined by a detailed evaluation rather than a single test. Programs weigh your cardiac hemodynamics, pulmonary pressures and their reversibility, kidney and liver function, frailty, nutrition, prior surgeries, and psychosocial support. Some apparent barriers, such as elevated pulmonary pressures or marginal kidney function, can be modifiable with optimization, while others are fixed. A second opinion confirms whether the eligibility determination in your case matches what your records show and whether a path back to candidacy exists.
Destination therapy refers to a durable LVAD implanted as a permanent treatment for advanced heart failure in a patient who is not a candidate for transplant. Rather than serving as a temporary bridge to a donor heart, the device provides ongoing mechanical support for the life of the patient. Outcomes and quality of life with destination-therapy LVADs have improved substantially, and for many patients it is an appropriate and durable option. Our review weighs destination therapy against transplant and continued medical therapy for your specific situation.
The most important records are your echocardiogram, your right heart catheterization (pulmonary pressures, vascular resistance, and cardiac output), your left heart catheterization or coronary angiography, and a complete set of organ-function and metabolic labs. Cardiac CT or MRI, heart-failure clinic notes, prior surgical history, and any completed transplant or LVAD evaluation paperwork round out the picture. Our team helps you gather anything that is missing and can request records directly from your facilities with your authorization.
In most cases, no. Your White Glove Insights™ Report is delivered within 24 hours of receiving your complete medical records, which typically fits inside the evaluation and listing timeline for advanced heart failure. Acute decompensation requiring urgent mechanical support is a different situation that demands immediate treatment, and we would never advise delaying genuinely time-critical care. If your situation is urgent, contact our team to discuss an expedited turnaround.
Medically reviewed by Rahul R. Handa, MD — Cardiovascular & Thoracic Surgeon
Last reviewed: June 2026Get an independent Heart Team review — led by a cardiac surgeon and cardiologist, with triple risk-model scoring — before you commit. A written review is delivered within 24 hours of your records, from $500.