**4. Future developments**

The technology around mechanical circulatory support is evolving with an exponential speed which makes any prediction beyond few years futile. We can however look into current work that is focusing in the alleviation of VAD complications and is promising to become clinical practice in foreseeable future. One of these is contactless energy transfer that is combined with subcutaneous implantable batteries allowing transcutaneous energy transfer (TET) and avoid the driveline passing through the skin eliminating the 'Achilles' heel' of MCS Systems [23]. Further work involves strategies aiming for early and more sensitive recognition and treatment of certain complications especially the likes of pump thrombosis. These techniques use remote monitoring systems with in-time assessment and intervention of pump readings and parameters to more finely tune the VAD therapy [24]. Improved biocompatibility of materials used and rotor design will surely be helpful to reduce thrombosis risk as well as to reduce shear forces affecting blood components. Further miniaturisation and less invasive techniques of implantation can be expected to become more common place in the near future and will allow to expand the age spectrum of the recipients. Better understanding and management of right ventricular dysfunction may be coupled with more intuitive bi-ventricular support in order to achieve better and sustainable results. With improved results and better control of complications one can expect to broaden the spectrum of recipients to less sick patients and include Intermacs classes 5 and above to preemptively avoid end-organ dysfunction of heart failure patients.
