As the prevalence of advanced heart failure continues to rise, treatment strategies for select patients include heart transplantation or durable left ventricular assist device (LVAD) support, both of which improve quality of life and extend survival. Recently, the HeartMate 3 has been incorporated into clinical practice, the United Network for Organ Sharing donor heart allocation system was revised, and the management of LVAD-related complications has evolved. Contemporary LVAD recipients have greater preoperative illness severity, but survival is higher and adverse event rates are lower compared with prior eras. This is driven by advances in device design, patient selection, surgical techniques, and long-term management. However, bleeding, infection, neurologic events, and right ventricular failure continue to limit broader implementation of LVAD support. Ongoing efforts to optimize management of patients implanted with current devices and parallel development of next-generation devices are likely to further improve outcomes for patients with advanced heart failure.

Brigham and Women's Hospital Harvard Medical School Boston Massachusetts USA

Columbia University Irving Medical Center New York New York USA https twitter com ersied727

Henry Ford Hospitals Detroit Michigan USA

Institute for Clinical and Experimental Medicine Prague Czech Republic https twitter com netuka_ivan

University of Chicago Medicine Chicago Illinois USA https twitter com spinneymd

J Clin Anesth. 2023 May;85:111014. doi: 10.1016/j.jclinane.2022.111014. PubMed

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