Insertion of Left ventricular assist device (LVAD)s (artificial hearts that assist the circulation) in patients with advanced heart failure with deteriorating clinical status is life-saving and they are being inserted into an increasing number of patients with advanced heart failure. LVAD technology is evolving very quickly. LVADs were initially inserted as a bridge to transplantation in patients with advanced heart failure with deteriorating clinical status unable to wait any longer for heart transplantation and the decrease in donors means that an increasing number of patients are requiring LVAD support for survival when their clinical status deteriorates. There is also now compelling evidence that with LVAD unloading recovery of the patients myocardial function can also occur, particularly when combined with pharmacologic therapy, allowing device removal avoiding the need for transplantation, immunosuppression and its associated complications and leaving the patient with an excellent quality of life. This indication, known as “bridge to recovery” is a newer and expanding indication. The future use of LVADs, particularly as survival continues to increase, is extending to their wider use as destination therapy, when the device is inserted lifelong as an alternative to transplantation and this role is likely to increase more in the future.
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