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so hes gonna introduce our next speaker dr. Ashraf Guha he is our associate director of the VAD program at our Hospital as well as director of the RV failure and pulmonary hypertension program hes going to be talking about advanced heart failure therapy and L beds welcome yeah try to fit you know three days of conference into 15 minutes but so quickly go or you know end-stage heart failure and mechanical assist devices so during this talk well go over a natural history of heart failure clinical risk assessment in terms of how to assess end-stage heart failure and role of hemodynamics and exercise testing and a brief introduction to continuous flow el Vettes and just a couple of slides on second and third-generation elements so as a transition to what are windows so just as a transition to what our wind was talking what he was talking mainly on acute decompensation heart failure and on cardiogenic shock this is the clinical course of somebody with chronic stable heart failure who as