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Indications of assist devices concern (a) patients with severe/endstage heart failure on waiting list for heart transplantation a bridge to transplant"; (b) " Bridge to recovery" for patients at imminent risk of death due to acute cardiac failure; (c) "Destination therapy" with chronic implantation due to the imbalance between needs and scarcity of cardiac donors. Classical criteria of implantation correspond to severe heart failure resistant to available therapies. In order to avoid too advanced situations, many investigators recommend to discuss assist devices in patients who are dependent on inotropic support or in whom a progressive increase in inotrope doses is needed to maintain an adequate hemodynamic status. Choice of devices includes pneumatic paracorporeal/intracorporeal machines or electromechanical devices. In case of right and left cardiac failure, biventricular assist devices are needed. A significant reduction in death while on waiting list for heart transplant has resulted from technological progresses in assist devices. However; the benefit/risk must be evaluated individually, taking into consideration contraindications and complications such as thrombosis, bleeding, stroke or infection.