**5. Conclusion**

Over the last decades, there have been revolutionary developments in mechanical support. Although patients with chronic heart failure exhibit improved survivorship with the application of evidence-based medical therapies, VADs are superior to medical therapy for improving survival among patients with advanced heart failure with reduced ejection fraction [18]. This topic is important because estimates reveal that over 18 million persons are diagnosed with heart failure in the United States and Europe at present [17]. Furthermore, heart failure is far more prevalent in older age groups, reaching 4.3% among persons aged 65–70 years in 2012, and is projected to increase steadily, reaching 8.5% in the US by the year 2030 [17].

For individuals with refractory heart failure requiring transplantation, it has been estimated that a VAD is used as a bridge to transplantation in approximately 9% of children and 25% of adult patients The shortage of donor organs and the expanding pool of patients with heart failure have led to growing interest in mechanical circulatory support; fortunately, we have observed meaningful and positive trends from the incorporation of MCS over the past five decades. We commend all those individuals who have been at the forefront of these developments and equally acknowledge those with behind-the-scenes contributions to this field.

As of today, this modality has been successfully expanded to employ MCS as bridge-to-transplant, bridge-to-recuperation, or destination therapy. However, following the withdrawal of HVAD from the global market in June of 2021, we are currently left with a reduced armamentarium for managing patients with advanced heart failure with reduced ejection fraction, particularly in the pediatric population. Therefore, shifting the paradigm to advance device miniaturization, improving surgical implantation techniques, and effectively reducing adverse events would be of greatest value in the following decades to further advance the field of mechanical circulation. An integrative alliance among technology companies, healthcare practitioners, and researchers is paramount to promoting education, innovation, and accessibility.
