**1. Introduction**

Heart failure (HF) affects approximately 6 million adults in the United States (US) and is projected to affect over 8 million persons over the age of 18 years by the year 2030 [1]. Of these, it is estimated that the prevalence of advanced heart failure (American College of Cardiology/American Heart Association Stage D) ranges between 250,000 and 300,000 individuals. Between 1988 and 2021, over 83,000 heart transplants were performed in the US. Among those patients, a ventricular assist device (VAD) was used in over 20,000 or approximately 25% of transplantations [2]. Pediatric patients (≤17 years old) comprised 31% of total transplantations, and approximately 9% of children required a VAD as a bridge to transplantation (BTT) [2].

A description of noteworthy milestones in the history of cardiac surgery and mechanical support must include the meaningful advances led by Dr. John H. Gibbon in the 1950s. These advances laid the foundation for the use of cardiopulmonary bypass (CPB) and circulatory assist devices to support patients with perioperative complications and prolonged hemodynamic recovery [3, 4]. Since the early days of mechanical circulatory support (MCS), VADs have become a standardized alternative strategy to bridge to hemodynamic recovery, destination therapy, a bridge during decision-making for the next steps in management, or as a BTT [5].

The first clinical use of a LVAD was reported by Liotta *et al*. in 1963, in a patient with cardiac arrest the morning after aortic valve replacement. The intrathoracic pump was still functioning 4 days postoperatively when the patient died due to brain damage, a complication of cardiac arrest they experienced prior to LVAD implantation [6]. In 1964, The National Institutes of Health (NIH) became actively involved in the development of mechanical assist devices with the inception of the Artificial Heart Program [7]. By 1966, the first successful pneumatically driven paracorporeal left ventricular assist device (LVAD) was employed by DeBakey et al. to support a patient following cardiac surgery. The first human heart transplant was performed by Dr. Christiaan Barnard in 1967, and shortly afterward the use of artificial ventricle technology was initiated as a bridge to support patients until a donor heart could be found [8–10]. Concurrently, the idea of replacing the entire organ using an "artificial pump" came to clinical practice in 1969 by Cooley *et al*. who reported the first use of a total artificial heart (TAH) as a BTT. However, this device was only able to be retained for a few days due to adverse events such as infection, thrombosis, and hemolysis [11].

The establishment of the National Heart, Lung, and Blood Institute (NHLBI) by the NIH in the 1970s promoted the development of implantable devices intending to provide longer mechanical support [7]. In 1978, the first LVAD was used by Norman et al. for nearly 6 days as a BTT [12]. The first TAH intended for permanent support was implanted in 1984 by DeVries et al. with the patient being supported for 112 days before succumbing to sepsis [13].

The first successful BTT case using a VAD was reported by Portner *et al.* in 1984 using the Novacor (Baxter Healthcare Corporation, Oakland, CA) implantable electrical LVAD in a patient with ischemic end-stage heart disease [14]. By the mid-1990s, the FDA approved multiple pulsatile devices allowing patients to recover from hemodynamic compromise [15] (**Figure 1**). Subsequently, in the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial, a new indication for mechanical support was explored and the trial revealed

*A Historical Review of Mechanical Circulatory Support DOI: http://dx.doi.org/10.5772/intechopen.110525*

that patients supported by a LVAD exhibited an 81% improvement in 2-year survival compared to medical therapy in patients with advanced heart failure who were not candidates for heart transplantation [5, 16]. The results of this trial led to the approval of the HeartMate VE LVAD device for destination therapy in 2003.

As the prevalence of advanced heart failure increased over the past decades, utilization of LVADs became essential to improve pre-transplant illnesses, improve quality of life, and enhance survivorship—a phenomenon primarily driven by advances in device design, patient characteristics, implantation techniques, and long-term management of adverse effects [17, 18].
