Continuous flow blood pumps: the new gold standard for advanced heart failure?

Consider the familiar phrase ‘cardiac transplantation sets the gold standard for the treatment of severe heart failure’. Does this still ring true? For the advanced heart failure (AdHF) patient, the primary objective is to provide symptomatic relief from intolerable breathlessness, lethargy and fatigue [1]. The secondary aim, conditional upon the primary objective being met, is to extend life. Neither is accomplished easily in refractory Stage D heart failure (New York Heart Association (NYHA) IV). Conventionally, at this stage, only cardiac transplantation or palliative care options remain. The former may offer symptomatic relief and extended life for a carefully selected minority [2]. In contrast, opiates or inotropes may accelerate death for the great majority. These patients typically experience at least three periods of hospitalization during their last 6 months of life. The costs of dying are considerable, and the end-of-life/dying trajectory notoriously difficult to predict for any individual [3].