Left ventricular assist devices.

Left ventricular assist device (LVAD) insertion in patients with advanced heart failure with deteriorating clinical status is life saving, and LVADs are now being inserted into an increasing number of patients with advanced heart failure. They were initially inserted as a bridge to transplantation, and the decreased availability of donor hearts means that an increasing number of patients are requiring LVAD support for survival when their clinical status deteriorates. There is strong evidence that with LVAD unloading, particularly when combined with pharmacological treatment, the patients' myocardial function can also recover, allowing device removal and avoiding the need for transplantation, immunosuppression and its associated complications. 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 further. LVAD technology is evolving quickly, survival is improving, the incidence of complications is decreasing and durability of the devices is improving.