AUTHOR Joseph G. Rogers, MD
The growing population of patients progressing to end-stage heart failure paradoxically represents our field’s greatest success and failure. Individuals with previously mortal heart diseases now survive as a result of improved diagnostics, therapeutic innovation, and focused patient care efforts across an array of cardiovascular conditions, particularly ischemic heart disease. Unfortunately, myocardial injury with its attendant neurohormonal activation too commonly results in an insidious deterioration in cardiac function that is slowed (but not halted) by contemporary heart failure treatments. The result of our success is increasing pressure on heart failure teams to devise new and effective strategies that mimic the benefits of transplantation for the larger cohort with advanced heart failure. With little doubt, broader application of mechanical circulatory support has played an important role in filling this void and arguably has been the most epidemiologically impactful treatment in the history of advanced heart failure therapy.