Abstract
Medical and electrical therapies for systolic heart failure have improved outcomes and altered the natural history of the disease. Although heart transplantation remains the most successful treatment option for patients with advanced heart failure refractory for these treatment, cardiac transplantation is available for only a minority of patients because of the lack of suitable donor hearts. As a consequence of limited donor availability, left ventricular assist device (LVAD) therapy has become an established treatment for patients with advanced heart failure as either a bridge to transplantation (BTT) or as a permanent alternative to transplantation, i.e., destination therapy (DT). The Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial provided a firm albeit inauspicious proof of concept for the use of blood pumps as an alternative to medical therapy in patients not eligible for transplantation. Small continuous-flow LVADs improved the probability of survival and reduced the risk of device failure compared to larger pulsatile-flow LVADs. Axialflow LVADs have been the most popular option for mechanical circulatory support. Along with axial-flow blood pumps, some centrifugal blood pumps have also been developed aiming at achieving mechanical circulatory support as well as long-term durability.
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