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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.<\/jats:p>","DOI":"10.1093\/eschf\/xvag201","type":"journal-article","created":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T11:38:43Z","timestamp":1784374723000},"source":"Crossref","is-referenced-by-count":0,"title":["Indication for durable mechanical circulatory support: an expert opinion review"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8221-1295","authenticated-orcid":false,"given":"Felix","family":"Schoenrath","sequence":"first","affiliation":[{"name":"Deutsches Herzzentrum der Charit\u00e9, Department of Cardiothoracic and Vascular Surgery , Augustenburger Platz 1, Berlin 13353 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