Mechanical circulatory support devices in heart failure: a narrative review of current evidence, clinical applications, complications, and future directions

Mechanical circulatory support devices (MCSDs) have evolved from rescue therapy for refractory cardiogenic shock (CS) to an essential component of advanced heart failure management, spanning temporary support, bridge strategies, durable left ventricular assist device (LVAD), and total artificial heart (TAH). This structured narrative review summarizes the historical evolution, current indications, device classification, major short-term and long-term platforms, adverse events, and future directions of MCSDs. Literature was selected in a structured narrative manner with emphasis on contemporary guidelines, randomized or comparative studies, major registries, and representative Chinese experience. Available evidence shows that MCSDs can improve hemodynamics and, in selected populations, survival and quality of life; however, these benefits must be balanced against bleeding, stroke, infection, right heart failure, device malfunction, cost, and major ethical and access constraints. Current practice thus necessitates careful patient selection, stage-based therapeutic escalation, and rigorous evaluation of mixed evidence pertaining to temporary MCSDs, LVAD and TAH, instead of merely describing individual devices.