The increasing global prevalence of congestive heart failure is a major healthcare concern for high patients that has a poor prognosis and is associated with a greater than 70% mortality rate. The 1-year mortality for end-stage heart failure is greater than for most malignancies. When heart failure has gone beyond the treatment capacity of drug therapy, heart transplant is the gold standard to prolong end-stage heart failure patients’ lives.

In light of the ageing population, rising number of heart failure patients, and shortage of suitable donors for heart transplant, the ability to develop optimal mechanical cardiac replacement and assistance will help alleviate the growing problem. After more than 50 years of development, mechanical cardiac assistance in the form of ventricular assist devices (VADs) has become accepted as a therapeutic solution for end-stage patients. If a complete cardiac replacement is required, a total artificial heart (TAH) comes into play. Advent of various technologies, such as computational fluid dynamics, contactless suspension, and miniature electric drive technology, have allowed VADs and TAHs become more reliable and versatile in recent years. These devices are used for bridge to transplant, bridge to recovery, or even destination therapy. To date, application of TAHs is limited to a few centres worldwide and their long-term outcome remains in doubt. In contrast, the simpler and smaller VADs are now in the 3rd generation and become the most commonly used devices for cardiac support.

In the lecture, we will go through the history of development for mechanical cardiac replacement and assistance. By looking into various devices in clinical use and on the horizon, we will discuss the technologies and design perspectives behind them. In addition to the current status of cardiac assistance, as well as the device categorization, the outlook and considerations for successful development of future VADs will be discussed.