Options for temporary mechanical circulatory support

Abstract

Temporary mechanical circulatory support (MCS) refers to a group of devices generally used for less than 30 days to maintain adequate organ perfusion by compensating for a failure of the pumping mechanism of the heart. The increased availability and rapid adoption of new temporary MCS strategies necessitate physicians to become familiar with devices placed both percutaneously and via median sternotomy. This review will examine the different options for commonly used temporary MCS devices including intra-aortic balloon pumps (IABPs), veno-arterial-extracorporeal membrane oxygenation (VA-ECMO), TandemHeart(®) (CardiacAssist, Pittsburg, PA, USA) Impella(®) and BVS 5000(®) (both Abiomed Inc., Danvers, MA, USA), CentriMag(®) and Thoratec percutaneous ventricular assist device (pVAD)(®) (both Thoratec Corporation, Pleasanton, CA, USA). A specific emphasis will be made to describe relevant mechanisms of action, standard placement strategies, hemodynamic effects, relevant contraindications and complications, and important daily management considerations.

Keywords: CentriMag; Left ventricular assist device (LVAD); TandemHeart; biventricular assist device (BIVAD); extracorporeal membrane oxygenation (ECMO); percutaneous ventricular assist device (pVAD); right ventricular assist device (RVAD).