Mechanical Circulatory Support in Advanced Heart Failure

Abstract

Advanced heart failure (HF) with persistent and progressive clinical decline despite maximal medical therapy portends a high mortality in the absence of advanced therapies, such as ventricular assist devices or heart transplantation. A subset of these advanced HF patients deteriorates into refractory cardiogenic shock, that is challenging to manage with vasoactive agents alone. Temporary mechanical circulatory support (MCS) device options have evolved over the years and provide a viable option to rescue and rest the myocardium of patients in cardiogenic shock. The goal of such therapy is to serve as bridge to recovery, or more often, a bridge to durable advanced therapies. For those patients with progressive advanced HF despite extensive medical therapy, durable MCS devices (ventricular assist devices) are available when heart transplantation is not feasible. In this article, we review currently available temporary and durable MCS devices, with a focus on their hemodynamic profiles, to inform optimal device selection for patients with advanced HF.

Comparison of Suture-Based and Collagen-Based Vascular Closure Devices for Large Bore Arteriotomies—A Meta-Analysis of Bleeding and Vascular Outcomes

“…On the similar terms, both categories of devices may lead to other complications including distal embolization of the plug (in C-VCD) or foot plate (in S-VCD) and can also lead to infections of the arterial or access site [ 39 , 40 , 41 ]. Some of these factors may be non-modifiable, such as age and gender, but the introduction of intravascular lithotripsy facilitated transfemoral TAVR [ 42 , 43 ] or the reduction in sheath sizes with newer devices [ 44 ] may play important roles in the reduction of poor outcomes in LBA and further delineate any differences in the outcomes of these two VCDs.…”