Left ventricular assist devices (LVADs) are the treatment of choice for advanced heart failure that is refractory to medical therapy for both Bridge to Transplantation and Destination Therapy in appropriately selected patients. The newer continuous flow LVADs are more reliable and durable and have resulted in significant size reduction compared to pulsatile flow LVADs. This "miniaturization" of the LVAD has potential advantages including less surgical trauma for implantation. The HeartWare HVAD is a new continuous flow LVAD, currently in trials, that is designed to be implanted and contained completely within the pericardial space.
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