[Implantable Left Ventricular Assist Device].

Drug-resistant severe heart failure significantly impairs cardiac pump function, affecting both prognosis and quality of life (QOL). When conventional treatments are ineffective, a ventricular assist device (VAD) can support heart function. Heart transplantation remains the ultimate treatment, but donor shortages and eligibility constraints limit access. The left ventricular assist device (LVAD) is a crucial option, serving as a bridge to transplantation (BTT) or a permanent destination therapy (DT) for ineligible patients. In Japan, DT was covered by insurance in 2021, expanding from 7 to 19 facilities by 2023. Key differences between BTT and DT include the removal of the age limit (65 years) and reduced caregiver requirements. LVAD technology has advanced, with miniaturization improving implantation feasibility and reducing surgical burden. Pump designs have evolved from pulsatile to continuous-flow types, with axial and centrifugal models enhancing efficiency. Innovations in biocompatibility and wireless power transmission aim to reduce complications and improve long-term outcomes. BiVACOR, a fully implantable total artificial heart using magnetic levitation, was first clinically tested in 2024. While currently limited to temporary use before transplantation, further advancements may lead to broader applications, enhancing patient survival and QOL.