Permanent Left Ventricular Assist Devices: Long-Term Management and Outcomes.

This article outlines the historical development, physiologic principles, and contemporary clinical management of durable left ventricular assist devices, with a primary focus on the HeartMate 3 era. An understanding of centrifugal pump physiology, pulsatility index, power, and flow estimation is essential for effective long-term patient management. While major complications such as pump thrombosis and stroke have declined, gastrointestinal bleeding, right ventricular failure, infection, arrhythmias, and outflow graft obstruction remain a significant clinical challenge. Nonetheless, left ventricular assist device therapy as a bridge to transplant, destination therapy, and even recovery are feasible strategies in the context of ongoing donor organ shortages.