A Ventricular Assist Device As a Bridge to Recovery, Decision Making, or Transplantation in Patients with Advanced Cardiac Failure

Despite many advances in the management of patients with heart failure, acute cardiogenic shock and progressive congestive heart failure remain serious problems with dismal prognoses. Both temporary and permanent mechanical support has been gaining wide clinical application in this patient population. Although mechanical circulatory support technology is rapidly evolving, this approach is associated with multiple issues such as the optimal duration of temporary support, ideal timing to bridge these patients to a long-term device, and selection of the right device for the right patient. The currently available devices are categorized into two major groups: temporary and long-term devices (including destination therapy). Heart failure is a dynamic condition, and the therapeutic approach may need to be modified depending on the patient's condition. Furthermore, the patient's preexisting morbidity, age, socioeconomic status, and family support are confounding factors that need to be considered when making such decisions. Clinical trials including prospective studies, as well as meticulous analysis of existing data, may help develop universal guidelines to select the right device. This manuscript will review the most widely used ventricular assist devices.