The ventricular assist device: a bridge to ventricular recovery, a bridge to heart transplantation or destination therapy?

Despite advances in pharmacological treatments aimed at a neurohormonal blockade for heart failure, there is still a growing number of patients with advanced symptoms who suffer significant morbidity and mortality. At present the most effective cure for end-stage congestive heart failure is cardiac transplantation. This method is severely limited owing to a lack of available organs. This is why ventricular assist devices (VADs) capable of completely supporting the circulation are taking on an increasingly important role in heart failure therapy. VADs are important bridges to cardiac transplantation. The Randomised Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial revealed that they could be used as long-term destination therapy for non-transplant candidates. The latest studies show that VAD support may also function as a bridge to ventricular recovery and enable this procedure to take place. Apart from foreign devices, there is the Polish system (PCAS), which is being prepared for introduction into global practice. (Cardiol J 2007; 14: 14-23).