Novel percutaneous mechanical circulatory support devices and their expanding applications

Abstract

Temporary mechanical circulatory support (MCS) is a common supportive therapy in cardiogenic shock and high-risk coronary intervention. The proliferation of new percutaneous MCS devices allows support to be instituted rapidly without surgical cutdown. The recent literature exploring the indications, benefits, and risks of each is reviewed. Areas discussed: Current applications of percutaneous MCS devices, including intra-aortic balloon pumps (IAPB), Impella, TandemHeart, and VA ECMO are discussed. Studies investigating each were identified through a combination of online database queries and direct extraction of single studies cited in previously-identified papers. Information on unpublished trials and registries was found on ClinicalTrials.gov. Expert commentary: Direct VADs provide a higher level of hemodynamic support compared to IABP and their early use will continue to expand. The development of percutaneous RV support systems may allow more patients to receive such therapy faster. VA ECMO is being used increasingly in CPR and in outreach programs.

The novel ProtekDuo ventricular assist device: Configurations, technical aspects, and present evidence

“…When connected to a pump system, the RV can be bypassed and decompressed (Figure 1(b)). 8 The ProtekDuo may provide around 4.5 L of blood flow per minute and represents veno-pulmonary (V-P) extracorporeal life support (ECLS). The device is relatively new and only little literature is available.…”

Impact of Postoperative Liver Dysfunction on Survival After Left Ventricular Assist Device Implantation

“…Although our data are insufficient to support such a recommendation, the liberal use of early right ventricular assist device therapy may be beneficial in patients with post-LVAD right-sided heart failure, particularly in the setting of combined hypertransaminasemia and hyperbilirubinemia. This therapy may be facilitated by the proliferation of percutaneous right-sided support devices [28].…”

Reality or singular pipe dream?

“…In part, this concept has been demonstrated with devices currently being used for adults, the latter albeit without the transapical approach. [2][3][4] Assuming the approach works well, one can debate the merits of a single-cannula paracorporeal system versus other neonatal support options (eg, extracorporeal membrane oxygenation, other dual cannulation, paracorporeal nonextracorporeal membrane oxygenation strategies). I will not focus on the many viewpoints that may exist on this issue.…”