Durable Mechanical Circulatory Assist Devices for Heart Failure

Mechanical circulatory support (MCS) for the failing heart is now the mainstay of the modern management of patients with both acute and chronic heart failure refractory to pharmacologic and other usual interventions. In fact, the successes realized to date have been so significant that the main focus of this arena has now shifted away from simple survival to mitigation of risk and minimization of adverse events. Undeniably, continued advances in device technology have made this possible, but when coupled with analyses of the ever-growing patient management experience, better understandings now exist regarding: optimal patient selection and timing of intervention, the significant improvement in multiorgan function during the time spent on device support, and preexisting and demographic risk factors that may result in complications during support, the end result of which are significantly improved outcomes compared to prior decades. In scenarios where an LVAD alone would not be sufficient, the implantable total artificial heart has seen an enormous resurgence of interest as a bridge to transplantation for patients with biventricular failure.