Surgical treatments for patients with terminal heart failure: mechanical support compared with transplantation.

Heart transplantation remains the gold standard treatment for patients with terminal end-stage heart failure. Although results reported have been excellent, older recipients and donors associated with significant comorbidities are now the rule rather than the exception. Moreover, heart failure has become a significant public health problem with a growing population of patients in countries unable to answer the demand for transplantation. An emerging answer to this dilemma comes from results reported with the use of continuous flow pumps where patient survival approaches 80% one and 2 years after implantation in selected patients. Is it time to triage patients to continuous flow pumps? Should we recommend continuous flow pump implantations in patients with various comorbidities, and offer transplantation to a selected group of patients who will reach the long-term benefit of the procedure?