title: Role of long-term mechanical circulatory support in patients with advanced heart failure.
abstract: Advanced heart failure represents a small proportion of patients with heart failure that possess high-risk features associated with high hospital readmission rates, significant functional impairment and mortality. Identification of those who have progressed to, or are near a state of advanced heart failure should prompt referral to a service that offers therapies in mechanical circulatory support (MCS) and cardiac transplantation. MCS has grown as a management strategy in the care of these patients, most commonly as a bridge to cardiac transplantation. The predominant utilisation of MCS is implantation of left ventricular assist devices (LVAD), which have evolved significantly in their technology and application over the past 15-20 years. The technology has evolved to such an extent that Destination Therapy is now being utilised as a strategy in management of advanced heart failure in appropriately selected patients. Complication rates have decreased with VAD implantation, but remain a significant consideration in the decision to implant a device, and in the follow up of these patients.
authors.affiliation: Department of Advanced Heart Failure/Transplantation, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: M B
authors.initials: MB
authors.lastname: Stokes
authors.affiliation: Department of Advanced Heart Failure/Transplantation, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Bergin
authors.affiliation: Department of Advanced Heart Failure/Transplantation, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: D
authors.initials: D
authors.lastname: McGiffin
mesh_terms: D019468:Disease Management; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000639:trends*; D006801:Humans; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
keywords: advanced heart failure; bridge to recovery; bridge to transplantation; destination therapy; left ventricular assist device; mechanical circulatory support