Baudry and colleagues reported trends in durable mechanical circulatory support (MCS), primarily left ventricular assist devices (LVADs), across Europe from 2018 to 2023.¹ They highlighted the underutilization of durable MCS, despite heart failure (HF) remaining a leading cause of mortality. Their hypotheses—improvements in medical therapies, referral delays to advanced HF units, the COVID-19 pandemic, and changes in graft allocation—are valid. However, the period from 2018 to 2023 cannot be considered a single therapeutic era, as significant advancements in HF with reduced ejection fraction (HFrEF), including sodium–glucose cotransporter 2 inhibitors and vericiguat (in some countries), were only implemented in 2022.²

We commend the authors for this unprecedent analysis but would like to offer a more optimistic perspective. Since 2022, durable MCS including LVADs and Aeson® total artificial hearts (TAHs) have been gaining traction in Europe. LVAD implantations increased across most countries between 2022 and 2023, from +2% in Austria to +25% in the Czech Republic and Germany, and + 51% in Poland. Though France initially lagged, it is showing strong momentum in 2024 with 118 LVADs (matching 2023's total) and forecasts of 165 LVADs by the end of the year. Additionally, 45 Aeson® TAH devices have been implanted across Europe since the programme resumed in November 2022, primarily in France, Germany, and Italy. Once again, France leads the way with 20 TAHs already implanted and a projection of 30 by the end of the year.

Awareness is growing that death from HF is no longer inevitable and that durable MCS is an accessible, life-saving therapy. First, clinicians recognize that despite optimal medical management, one in five HFrEF patients progresses to advanced HF and may require durable MCS.³ Second, improved communication within the cardiology community has increased acceptance of durable MCS. The rise in advanced HF sessions at congresses and a growing body of scientific publications reflect this trend. As expertise grows in implantation, device optimization, and long-term management, physicians are more confident in highlighting the benefits of durable MCS rather than focusing on its drawbacks.

More physicians now regard durable MCS as an option for life. The European ELEVATE registry has been instructive, providing real-world data easily translatable to clinical practice showing a 5-year survival rate of 63% with LVAD, alongside significant improvements in functional capacity and quality of life.⁴ In parallel, physicians are gradually recognizing that durable MCS and heart transplant are complementary, not competing. Durable MCS is a valuable bridge to transplant for critically ill INTERMACS 1–2 patients, provides crucial rehabilitation and family time for INTERMACS 3–4 patients at limited access to transplant. It also provides an alternative for those with contraindications including age, pulmonary hypertension, obesity. Finally, public awareness campaigns at local and national levels are crucial in demystifying, destigmatizing and promoting durable MCS.

The revolution is underway. Let us make it our revolution.

Baudry 及其同事报告了 2018 年至 2023 年欧洲耐用机械循环支持 （MCS） 的趋势，主要是左心室辅助装置 （LVAD）。¹ 他们强调了耐用 MCS 的利用不足，尽管心力衰竭 （HF） 仍然是导致死亡的主要原因。他们的假设——药物治疗的改善、转诊到晚期 HF 病房的延迟、COVID-19 大流行以及移植物分配的变化——是有效的。然而，2018 年至 2023 年不能被视为单一的治疗时代，因为射血分数降低的 HF （HFrEF） 的重大进展，包括钠-葡萄糖协同转运蛋白 2 抑制剂和 vericiguat（在一些国家），直到 2022 年才实施。^{阿拉伯数字}

我们赞扬作者的这种前所未有的分析，但希望提供更乐观的观点。自 2022 年以来，包括 LVAD 和 Aeson® 全人工心脏 （TAH） 在内的耐用 MCS 在欧洲越来越受欢迎。2022 年至 2023 年期间，大多数国家的 LVAD 植入率有所增加，从奥地利的 +2% 增加到捷克共和国和德国的 +25%，波兰的 +51%。尽管法国最初落后，但它在 2024 年显示出强劲的势头，有 118 个 LVAD（与 2023 年的总数持平），预计到今年年底将有 165 个 LVAD。此外，自 2022 年 11 月该计划恢复以来，欧洲各地已植入 45 个 Aeson® TAH 器械，主要分布在法国、德国和意大利。法国再次领先，已经植入了 20 个 TAH，预计到今年年底将植入 30 个 TAH。

人们越来越意识到 HF 导致的死亡不再是不可避免的，持久的 MCS 是一种可及的、挽救生命的疗法。首先，临床医生认识到，尽管进行了最佳医疗管理，但五分之一的 HFrEF 患者会发展为晚期 HF，可能需要持久的 MCS。³ 其次，心脏病学界内部沟通的改善提高了对耐用 MCS 的接受度。大会上高级 HF 会议的增加和越来越多的科学出版物反映了这一趋势。随着植入、设备优化和长期管理方面的专业知识的增长，医生更有信心强调耐用 MCS 的优势，而不是关注其缺点。

现在，越来越多的医生将耐用的 MCS 视为终生的选择。欧洲 ELEVATE 登记库具有指导意义，提供了易于转化为临床实践的真实世界数据，显示 LVAD 的 5 年生存率为 63%，同时功能能力和生活质量也有显著改善。⁴ 与此同时，医生们逐渐认识到，持久的 MCS 和心脏移植是互补的，而不是竞争性的。Durable MCS 是 INTERMACS 1-2 危重症患者移植的宝贵桥梁，为移植机会有限的 INTERMACS 3-4 患者提供重要的康复和家庭时间。它还为那些有禁忌症的人提供了一种选择，包括年龄、肺动脉高压、肥胖。最后，地方和国家层面的公众意识运动对于揭开、消除污名化和促进持久的 MCS 至关重要。

革命正在进行中。让我们让它成为我们的革命。