Indication for durable mechanical circulatory support: an expert opinion review

Advanced heart failure represents a significant and expanding clinical challenge, establishing durable mechanical circulatory support as the critical therapeutic pillar, whether utilized as a bridge to transplantation or as a standalone therapy. This expert review provides a contemporary clinical decision framework that supplements existing guidelines by shifting the primary focus towards the pre-operative phase and the essential multidisciplinary processes required for clinical success. This review emphasizes precise patient selection and pre-operative optimization strategies designed to mitigate medical harm. This is particularly important in complex scenarios with relevant cardiac and non-cardiac comorbidities and in early stages of advanced heart failure to adequately address specific high-risk populations and conditions. By codifying the necessity of interdisciplinary team dynamics, targeted ambulatory as well as in-hospital workups, and shared decision-making, this review provides a structured approach to ensure equitable access and optimal long-term survival within the evolving landscape of advanced heart failure care.