Heart failure (HF) is a common disease associated with high morbidity and
mortality rates despite advanced pharmacological therapies. Heart transplantation
remains the gold standard therapy for end-stage heart failure; however, its
application is curtailed by the persistent shortage of donor organs. Over the
past two decades, mechanical circulatory support, notably Left Ventricular Assist
Devices (LVADs), have been established as an option for patients waiting for a
donor organ. This comprehensive review focuses on elucidating the benefits and
barriers associated with this application. We provide an overview of landmark
clinical trials that have evaluated the use of LVADs as a bridge to
transplantation therapy, with a particular focus on post-transplant outcomes. We
discuss the benefits of stabilizing patients with these systems, weighing
associated complications and limitations. Further technical advancements and
research on optimal implantation timing are critical to ultimately improve
outcomes and securing quality of life. In a world where the availability of donor
organs remains constrained, LVADs are an increasingly important piece of patient
care, bridging the critical gap to transplantation in advanced heart failure
management.