Destination therapy and total artificial heart: current status

The usefulness of the ventricular assistance as definitive therapy is one of the searched objectives since the first devices began to be developed. Technological improvements allowed designing current models while maintaining some concepts as wearability or electric power source. Surgical injury and associated morbidity have reduced promising outcomes. The clinical scenario for permanent assistance as first choice therapy is the group of patients with heart failure and refractory symptoms non-candidates for cardiac transplantation or those who cannot get access to transplant. The REMATCH trial entailed the scientific confirmation of that benefit. In this chapter the different available models for destination therapy, those already consolidated and those of more recent design and the existing experience are analyzed. The total artificial heart, which conceptually would be the paradigm of destination therapy, is considered in a specific section because its marked differences with the implantable, wearable left ventricular assist devices.