Since most patients with advanced HF will not be candidates for heart transplantation by virtue of age alone, this suggests a substantial increase in the potential demand for MCS-other things being equal. Importantly, because the incidence of heart failure (HF) rises with patient age, this portends a substantial growth in the HF demographic. ![]() ![]() Over the next 20 years, there will be a doubling of the population over 65 ( 2). Overall, the field of mechanical circulatory support (MCS) has been experiencing several salutary trends over recent years. Hence, there is still room for substantial improvement and mastery in knowledge as we continue to try to tackle this thwarting issue. Although guidelines have been recently published of how to best diagnose and manage patients presenting with ventricular assist device (VAD) thrombosis, most-if not all-of the guidelines are based on expert or consensus opinion and not on randomized trials ( 1). ![]() With all due apologies to Winston Churchill, the subheading of this keynote lecture signals how little is known about the subject of pump thrombosis (PT): it is a difficult problem to define, it is a difficult problem to understand, it is a difficult problem to diagnose, and it is a difficult problem to prevent and treat. Video 1 Pump thrombosis-A riddle wrapped in a mystery inside an enigma.
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