**5. Conclusions**

Within a relatively short period of emergence the implantation of left ventricular assist devices have made a huge impact in treatment of end-stage heart failure patients. The development of a new treatment method inevitably brings with it new challenges that limit its spectrum of utilisation. LVAD specific challenges which represent the limiting factors are mainly driveline infections, anticoagulation balances, cerebral incidents and right ventricular dysfunction. We can be optimistic that current research will lead to progress in tackling of these challenges so that we will be able to claim that this therapy method represents a first line management plan for HF patients. Notwithstanding the recent encouraging attempts of widening the donor pool to donation after circulatory death, the number of heart transplantation worldwide has reached a plateau and is only available to very few select types of patients. The prospect of much improved mechanical support methods for the circulation with better manageability represents a real hope for patients in wider age spectrum as well as in earlier phases of disease progression. Sooner or later MCS Systems that are available off the shelf and adaptable to each patients needs have the potential to replace heart transplantation for end-stage heart failure. However we may want to mention here that in parallel there are endeavours in bioengineering and gene-manipulation which could allow speculations into the 'off-the-shelf' availability of authentic spare organs for each person.
