Medical Care Versus Ventricular Assist Device for the Management of End-stage Heart Failure (MEVADE)

Inclusion Criteria: All patients presenting with end-stage heart failure defined as: * A left ventricular ejection fraction ≤25% * Or an oxygen consumption peak \< 14 mL/kg/min * Or severe symptoms (NYHA class III or IV) despite optimal medical treatment * Or a cardiogenic shock Exclusion Criteria: * Age over 70 years * Active neoplasia * Suspected or active systemic infection * Body mass index ≥40 kg/m2 * Severe chronic obstruction pulmonary disease * Evidence of intrinsic hepatic diseases defined as liver enzyme values ≥ 5 times the upper limit of normal within 4 days before the randomisation, or biopsy proven liver cirrhosis * Significant chronic renal impairment with persistent creatinine \>2.5 or clearance \< 25ml/min * Pregnant or lactating female * Patient under consideration for conventional revascularization procedures, therapeutic valvular repair, left ventricular procedure or cardiomyoplasty * Presence of implanted mechanical aortic valve that will not be converted to bioprothesis at the time of ventricular assist device implantation * Evidence of intrinsic hepatic diseases defined as liver enzyme values ≥ 5 times the upper limit of normal, or biopsy proven liver cirrhosis * Occurrence of stroke within 90 days or history of cerebrovascular disease with major (≥ 80%) extracranial or carotid stenosis documented by Doppler study * Confirmation by neurologist of impairment of cognitive function, presence of Alzheimer's disease or any other form of irreversible dementia or both * Major peripheral vascular disease accompanied by pain on rest or leg ulceration * Recent history of psychiatric disease that is likely to impair compliance * Drug or alcohol dependence * Difficult social surroundings