Heart failure (HF) is a major problem associated with high morbidityand mortality, and the prognosis from heart failure is worse thanthat for myocardial infarction or carcinoma of the bowel, breast, or prostate. Medical therapy with ACE inhibitors, β -blockers, angiotensin2 inhibitors, and aldosterone antagonists, together withresynchronization therapy, has improved the survival of many withHF, but there remain a large group of patients who, despite optimalmedical therapy, are in NYHA class III/IV HF with a very poorprognosis. Unfortunately the numbers of useable donor heartsavailable to...

Heart failure (HF) is a major problem associated with high morbidityand mortality, and the prognosis from heart failure is worse thanthat for myocardial infarction or carcinoma of the bowel, breast, or prostate. Medical therapy with ACE inhibitors, β -blockers, angiotensin2 inhibitors, and aldosterone antagonists, together withresynchronization therapy, has improved the survival of many withHF, but there remain a large group of patients who, despite optimalmedical therapy, are in NYHA class III/IV HF with a very poorprognosis. Unfortunately the numbers of useable donor heartsavailable to perform heart transplantation for these patients has significantly decreased over recent years and the number is totallyinadequate for the population who require heart transplantation.Left ventricular assist devices (LVADs) are rapidly evolving andare being increasingly used to treat patients with advanced HF. They are very efficient artificial hearts that assist the circulation andthey are being inserted into an increasing number of patients withadvanced HF. The LVAD technology itself is also evolving veryquickly. They were initially inserted as a bridge to transplantationin patients with advanced HF with deteriorating clinical status whowere unable to wait any longer for heart transplantation. They weremostly inserted into patients who, despite inotropic ± intra-aorticballoon pump (IABP) support, had deteriorating NYHA class IVHF and usually also end-organ dysfunction. Not only are LVADslife saving in these deteriorating patients who might otherwise diebefore a donor heart becomes available, but they also improve secondaryorgan function prior to transplantation, reduce pulmonaryhypertension, and allow for improvement of nutritional status. Thedecrease in donors means that an increasing number of patientshave been requiring support with a LVAD for survival when theirclinical status deteriorates.