Contemporary medical management of left ventricular assist device patients: integrating sex-specific perspectives

Purpose of review Durable left ventricular assist devices (LVADs) have become a cornerstone in the management of advanced heart failure, improving patient survival and quality of life. Long-term survival on LVAD support is approaching a decade, but women are less likely to be referred for implantation, remain underrepresented in LVAD trials, and experience a distinct adverse event profile. With longer periods on support, optimized medical management after LVAD has become increasingly important. It has been increasingly recognized that as hemocompatibility-related adverse events (HRAEs) have been reduced with current generation devices, hemodynamic-related adverse events (HDREs), including aortic insufficiency and heart failure, contribute significantly to patient morbidity after LVAD. This review summarizes contemporary advances in the medical management of these patients, integrating recent trials, professional society guidelines, emerging evidence, and highlighting sex-specific perspectives. Recent findings Recent literature highlights the burden of persistent congestion and heart failure after LVAD implantation, highlighting the importance of hemodynamic optimization, including individualized speed selection and blood pressure management, to mitigate HDREs. Evidence continues to support guideline-directed medical therapy to promote reverse remodeling and reduce morbidity, though utilization remains suboptimal. Advances in antithrombotic therapy, especially the reduced use of aspirin, are reshaping practice and further reducing gastrointestinal bleeding rates. Growing attention to reproductive health, including contraception counseling, pregnancy management, and medication safety, reflects an evolving recognition of sex-specific needs in LVAD care. Summary Persistent knowledge gaps, particularly regarding sex-specific management, highlight the need for inclusive, prospective research to inform evidence-based guidelines for the growing population of patients on chronic LVAD support.