Long-Term Survival After LVAD Implantation in End-Stage Heart Failure

Inclusion Criteria: 1. Adults aged ≥18 years 2. Diagnosis of end-stage heart failure refractory to optimal medical therapy 3. Scheduled to undergo left ventricular assist device (LVAD) implantation as part of routine clinical care 4. Able to provide written informed consent for participation and biospecimen collection 5. Willing and able to comply with study procedures and long-term follow-up 6. Availability of left ventricular apical myocardial tissue obtained during LVAD implantation surgery 7. Availability of peripheral blood samples collected during routine clinical care 8. Patients treated at participating study centers Exclusion Criteria: 1. Age \<18 years 2. Prior implantation of a durable mechanical circulatory support device 3. Concomitant heart transplantation at the time of index surgery 4. Congenital heart disease requiring complex surgical repair 5. Active systemic infection or sepsis at the time of LVAD implantation 6. Known active malignancy with a life expectancy \<1 year 7. Severe non-cardiac comorbidities limiting expected survival to less than 1 year (e.g., advanced liver failure, end-stage renal disease not eligible for renal replacement therapy) 8. Inability or unwillingness to provide informed consent 9. Pregnancy or breastfeeding at the time of enrollment 10. Inadequate quantity or quality of myocardial tissue or peripheral blood samples for planned analyses