Schoenrath, FelixBonios, MichaelIacovoni, AttilioJust, Isabell AnnaRoehrich, LuiseMiera, OliverBaudry, GuillaumeGal, Tuvia BenCrespo-Leiro, María GenerosaJoyce, EmerKapelios, Chris J.Lim, Hoong SernSkouri, HadiDamman, Kevin2026-08-242026-08-242026-07-21Schoenrath F, Bonios M, Iacovoni A, Just IA, Roehrich L, Miera O, Baudry G, Ben Gal T, Crespo-Leiro MG, Joyce E, Kapelios CJ, Lim HS, Skouri H, Damman K. Indication for durable mechanical circulatory support: an expert opinion review. ESC Heart Fail. 2026 Jul 4;13(4):xvag201.https://hdl.handle.net/2183/49077Review[Abstract] Advanced heart failure represents a significant and expanding clinical challenge, establishing durable mechanical circulatory support as the critical therapeutic pillar, whether utilized as a bridge to transplantation or as a standalone therapy. This expert review provides a contemporary clinical decision framework that supplements existing guidelines by shifting the primary focus towards the pre-operative phase and the essential multidisciplinary processes required for clinical success. This review emphasizes precise patient selection and pre-operative optimization strategies designed to mitigate medical harm. This is particularly important in complex scenarios with relevant cardiac and non-cardiac comorbidities and in early stages of advanced heart failure to adequately address specific high-risk populations and conditions. By codifying the necessity of interdisciplinary team dynamics, targeted ambulatory as well as in-hospital workups, and shared decision-making, this review provides a structured approach to ensure equitable access and optimal long-term survival within the evolving landscape of advanced heart failure care.engAttribution-NonCommercial 4.0 Internationalhttp://creativecommons.org/licenses/by-nc/4.0/Durable mechanical circulatory supportVentricular assist deviceAdvanced heart failureCardiogenic shockEuropean Society of CardiologyHeart Failure Associationjournal articleopen access10.1093/eschf/xvag201