It appears that an assist device ensures heart transplanta¬tion which improves survival. This treatment selection bias may be unethical and does not solve the transplant problem in North America or worldwide. Extensive research and funding for the development of a total artificial heart is a more logical strategy for the manage¬ment of end-stage heart failure in patients. Both the prevention of the underlying disease, atherosclerosis, that causes coronary artery disease and aggressive manage¬ment of hypertension to prevent the occurrence of heart failure carries the key to future survival.

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