Management of the ACC/AHA Stage D patient: mechanical circulatory support.

From humble beginnings in 1963 with a single desperately ill patient, mechanical circulatory support has expanded exponentially to where it is a viable alternative for advanced heart failure patients. Some of these patients are awaiting transplant but others will have a mechanical heart pump as their ultimate treatment. The history of MCS devices is reviewed, along with the 4 trials that define the modern era of circulatory support. The practical aspects of life with an MCS device are reviewed and common problems encountered with MCS devices. Future trends including miniaturization and development of completely contained MCS systems are reviewed.