*7.1. Heart Transplant and Mechanical Assist Device*

A possible treatment for end-stage HF in these patients is the use of left ventricle assist device (LVAD) as a destination therapy (DT) [71,72]. Recently, one patient has been transplanted after 47 months of Heart Ware L-VAD assistance and after accurate respiratory and orthopedic workup. After three months the follow-up was uneventful [73].

LVAD has been currently used in adult and pediatric population with end-stage HF as bridge to heart transplantation or as DT in selected adult patients with medically refractory HF who are not transplant candidates [74–77]. The mechanical assist devices have established their utility in increasing cardiac output and reversing end-organ damage [75–78]. LVAD therapy significantly produced a reverse ventricular remodeling through different mechanisms: reducing ventricular size, LV mass, and at microscopic level myocyte hypertrophy and improving function [79–85].

LVADs have been recently considered as a therapeutic option as destination therapy in DMD with advanced HF [86–88]. The use of mechanical circulatory support in DMD has been described in case reports and small series [86,87,89–93].

Selection of patients is crucial and several aspects should be considered (i.e., kyphoscoliosis, respiratory muscle weakness, and recovery and rehabilitation after surgery). Analysis of costs [94] showed that DT-VAD in DMD exceeds cost-effectiveness thresholds but was similar to cost-effectiveness estimates of DT-VAD in adults who are not transplant candidates.
