Will left-ventricular assist device therapy replace heart transplantation in the foreseeable future?

Implantation of circulatory assist devices as a permanent alternative to heart transplantation, so-called Destination Therapy, has become a promising new option for treatment of patients with advanced heart failure who are not candidates for heart transplantation.

The landmark REMATCH trial demonstrated that the implantation of left-ventricular assist devices is superior to any available medical therapy in patients with end-stage heart failure who are not eligible for transplantation.

Although the outcomes of device therapy are still limited by device durability and complications, the potential of Destination Therapy should continue to expand through the development of newer, smaller, and more innovative ventricular assist devices. This review discusses the current state of knowledge and future directions of Destination Therapy for end-stage heart failure.