[From circulatory support to artificial heart]

Various systems of mechanical circulatory support are now available: para-corporel devices, implantable ventricular assist devices, either portable or fully implantable. They allow treatment in a wide range of clinical indications, from untractable cardiac failure to cardiogenic shock. They are used in 3 different intention to treat: bridging to transplantation, bridging to recovery or definitive permanent implant. They are progressively becoming efficacious alternatives to cardiac transplantation. Their efficacy has reduced the actual need for a total artificial heart, which nevertheless keeps few indications. Various problems technological, clinical, economical and ethical have to be solved before a wide application of the method.