The future of mechanical circulatory support for advanced heart failure.

PURPOSE OF REVIEW: Mechanical circulatory support (MCS) has become the main focus of heart replacement therapy for end stage heart failure patients. Advances in technology are moving towards miniaturization, biventricular support devices, complete internalization, improved hemocompatibility profiles, and responsiveness to cardiac loading conditions. This review will discuss the recent advances and investigational devices in MCS for advanced heart failure.

RECENT FINDINGS: The demand for both short-term and long-term durable devices for advanced heart failure is increasing. The current devices are still fraught with an unacceptably high incidence of gastrointestinal bleeding and thromboembolic and infectious complications. New devices are on the horizon focusing on miniaturization, versatility for biventricular support, improved hemocompatibility, use of alternate energy sources, and incorporation of continuous hemodynamic monitoring.

SUMMARY: The role for MCS in advanced heart replacement therapy is steadily increasing. With the advent of newer generation devices on the horizon, the potential exists for MCS to surpass heart transplantation as the primary therapy for advanced heart failure.