Left Ventricular Assist Device as Destination Therapy

Mechanical circulatory support is the most rapidly evolving strategy in heart failure management. The growing number of patients who need better results than medical therapy can offer, the limited pool of donors for cardiac transplantation, and several technological breakthroughs have all made the option of implanting a left ventricular assist device (LVAD) as destination therapy more important. In this review, we outline the indications and decision making process of considering a patient for a destination therapy LVAD, as well as outcomes, complications, and issues related to management of patients on currently approved devices. The future direction of the field will be determined by progress in technology and by further improvement in size, durability, pump dynamics, and most importantly, by solving the problem of supplying energy to the pump without a percutaneous driveline.