The shortage of appropriate donor organs and the expanding pool of patients waiting for heart transplantation have led to growing interest in alternative strategies, particularly in mechanical circulatory support. Improved results and the increased applicability and durability with left ventricular assist devices (LVADs) have enhanced this treatment option available for end-stage heart failure patients. Moreover, outcome with newer pumps have evolved to destination therapy for such patients. Currently, results using nonpulsatile continuous flow pumps document the evolution in outcomes following destination therapy achieved subsequent to the landmark Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure Trial (REMATCH), as well as the outcome of pulsatile designed second-generation LVADs. This review describes the currently available types of LVADs, their clinical use and outcomes, and focuses on the patient selection process. 1. Introduction Heart transplantation is still the therapy of choice for patients with sustained heart failure resistant to any medical therapy. More than 16 million people are currently diagnosed with chronic heart failure (CHF) in Europe and the United States, where its prevalence averages 2.5% of the normal population [1, 2]. CHF increases significantly after age 65, and the population in this group will double within the next 20 years, suggesting heart failure incidence will similarly [3]. In the last decades, long waiting times for cardiac transplantation and subsequent increased mortality have led to an increase in the use of left ventricular assist devices (LVADs). Permanent mechanical circulatory support by new, smaller devices is a promising therapeutic option developed to provide an alternative to transplantation and to reduce mortality on the heart waiting list. The primary focus in this field was to develop a total artificial heart (TAH), but this has had limited success and, as a result, shifted attention to ventricular assist devices. The first-generation of implantable ventricular assist devices (VADs) were pulsatile, volume-displacement pumps. The start of the modern LVAD era began with the introduction of the HeartMate XVE in 1998. Although the XVE launched amidst great fanfare and high expectations, the device failed to displace the long-standing view that mechanical ventricular support was merely an expensive gimmick. These devices provide excellent circulatory support and improve survival until heart transplantation. However, they have many application limitations, such as
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