Assist devices for circulatory support in therapy-refractory acute heart failure

Abstract

Percutaneous mechanical circulatory assist devices can be implanted in an emergency setting in patients with acute cardiogenic shock refractory to conventional therapy irrespective of the given location. The choice for a specific mechanical circulatory assist device should be based on the underlying condition and individualized prognosis. Based on the findings of this review, circulatory or axial-flow pumps should be considered first-line devices.

Clinical outcome of mechanical circulatory support for refractory cardiogenic shock in the current era

“…3 Instead, short-term ventricular assist devices (VADs), which generally consist of internal cannulae and an external pump, have been developed for this application and have become a widely accepted treatment option in RCS. [4][5][6][7][8] In addition, there has been a resurgence of interest in veno-arterial extracorporeal membrane oxygenation (VA ECMO), as this approach has become safer and more reliable. [9][10][11][12][13] The bridge-to-transplant or destination therapy devices, as the second-stage treatment, require more durability and reliability, as well as feasibility of outpatient management.…”

Treatment Strategies for Patients with an Intermacs I Profile

“…Although severe aortic regurgitation is not an absolute contraindication, it will reduce the effectiveness of the pump. 9 Severe peripheral vascular disease may preclude femoral insertion. 6,8,10 Major complications of the Impella system include hemolysis, bleeding, limb ischemia (peripheral insertion), device malpositioning, endocardial or valvular injury caused by suction events, thromboembolism, and infection.…”

“…15 Widespread use of the TandemHeart has been limited by the need for transseptal placement of the inflow catheter, which, if not done during cardiovascular surgery, requires the expertise of trans-septal puncture by an electrophysiologist or interventional cardiologist. 9…”

“…7 The pump can provide up to 10 L/min of flow and is intended for up to 14 days of support. 9 A console displays the pump's rotational speed and flow rate (Figure 3 B). Although insertion is usually via a sternotomy, peripheral cannulation through the femoral artery and vein has also been reported.…”

Management of Advanced Heart Failure

“…Extracorporeal VADs may be located in a paracorporeal position, on the patient's anterior abdomen, or externally, at the patient's bedside. Several VAD systems have approval by the U.S. Food and Drug Administration (FDA) for clinical use or are under clinical development (Table 15.3) [66].…”