Role of Durable Mechanical Circulatory Support for the Management of Advanced Heart Failure

In the past decade, there has been a dramatic evolution in the field of mechanical circulatory support. Device-related complications continue to burden the field and will be a major obstacle for achieving therapeutic noninferiority compared with cardiac transplant. Selected patients with end-stage systolic heart failure enjoy an average survival of 80% at 1 year post-ventricular assist device implant, vastly better than survival rates of 25% to 50% on chronic inotrope support. Early patient referral to an advanced heart failure specialist before the onset of significant end-organ dysfunction and malnutrition is critical for achieving good operative outcomes.