Left Ventricular Assist Devices for the Treatment of Congestive Heart Failure

The mainstay of heart failure therapy is aggressive medical management with consideration of resynchronization therapy and automatic implantable cardioverter-defibrillator. This is best done with the support of a multidisciplinary team. Transplantation, when possible, remains the therapy of choice for patients who are refractory to medical therapy. Other options short of left ventricular assist device (LVAD) that should be considered include revascularization, mitral valve repair, and left ventricular remodeling procedures. LVAD therapy as a bridge to transplantation should be considered in patients with heart failure who are clinically deteriorating while on the transplant waiting list. This should be initiated prior to the onset of irreversible end-organ damage. In nontransplant candidates, an LVAD can be considered as an alternative to transplantation (destination therapy). However, cost and the availability of expertise continue to limit this therapy to quaternary care and research institutions.