Therapy with mechanical supports in advanced heart failure

Heart failure (HF) is the final event of virtually all cardiac diseases with a prevalence that has risen to epidemic levels in both Europe and North America. Medical therapy with angiotensin-converting enzyme inhibitors, beta-blockers, and aldosterone inhibitors associated with cardiac resynchronization therapy, when indicated, has allowed an improved survival for HF patients. However, morbidity and mortality rates for advanced HF remain unacceptably high, and the course of HF remains progressive so that patients end to a stage characterized by severe symptoms, poor quality of life, high hospitalization and mortality rates. Heart transplantation represents an effective surgical treatment for advanced HF, yet the interest for alternative surgical options has progressively increased due to shortage of donors and frequent contraindications. Several devices are currently available but the results of controlled studies are still unsatisfactory. It appears likely, however, that mechanical circulatory supports will play a major role in the management of patients with advanced HF.