**4. Current trends in mechanical circulatory support**

It has been estimated that survival rates in patients with continuous flow devices are 81% and 70% at 1- and 2-year post-implantation, respectively. Additionally, survival trends showed that outcomes are more satisfactory in VADs used for BTT than those in the DT cohorts. Nevertheless, even in the DT population, which inherently possesses greater comorbidities that contraindicate them for HT, long-term outcomes are still excellent exhibiting 68% overall survival at 2 years [66]. The Heartmate III recently achieved ~80% in the primary composite outcome of survival without disabling stroke or reoperation at 2 years [67]. Beyond implantation and the perioperative risks, this difference primarily resulted from a substantial reduction in the incidence of pump-related thromboembolic phenomena and reoperation due to device malfunctioning. Furthermore, data suggest that proactive implantation of VADs in patients with heart failure (INTERMACS classes 4–7) has excellent outcomes with a survival rate in the 80–95% range 1 year after implantation. Certainly, technological advances have made a significant difference in the last decades. In addition, at many centers, the selection of appropriate candidates for mechanical support has been developed to incorporate multidisciplinary evaluation before implantation. The harmonization of this approach provides meaningful benefits, as some studies have identified numerous comorbidities that are associated with poor outcomes. Such factors include limited life expectancy, active malignancy, multisystemic end-stage organ dysfunction, severe infections, hematologic dyscrasias, and anatomical and psychological components [66].
