Mechanical Circulatory Support

The role of mechanical circulatory device therapy has progressed rapidly over the last 2 decades, from supporting the failing heart in hospitalized patients awaiting heart transplantation to permanent or “destination” outpatient therapy in individuals with end-stage systolic heart failure (HF) for whom transplantation is not an option. Over this period, devices themselves have evolved through several generations. First-generation pulsatile devices have given way to secondand third-generation continuous flow ventricular assist devices (VADs), on the basis of axial and centrifugal flow, respectively. In this issue of the Journal, trueber et al. (1) report their experience with the HeartWare entricular Assist System (HeartWare, Inc., Framingham, assachusetts) as a bridge to cardiac transplantation in a ulticenter prospective nonrandomized single-arm clinical rial. In this cohort of 50 patients, survival to heart translantation, myocardial recovery and explant, or ongoing upport at 6, 12, and 24 months was 90%, 84%, and 79%, espectively.