Left Ventricular Assist Devices as Destination Therapy for End-stage Heart Failure

In the therapy of advanced heart failure, left ventricular assist devices represent an exciting new option. The role of mechanical circulatory support is currently limited predominantly by factors related to device durability. The population for whom mechanical circulatory support can be considered as permanent therapy is defined by those for whom improvement in survival and clinical function is expected from current devices. Reported device survival in the range of 50% at 1 year limits the present candidate population to those with greater than 50% mortality at 1 year, who are not eligible for cardiac transplantation, after which survival is 50% at 10 years. Even as we learn to identify these patients who are "sick enough" to warrant device placement and yet "well enough" to survive surgery, the devices and surgical techniques are evolving so that the outcomes are improving and the candidate population is expanding.