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. 2021 Jul 20;17(4):e274-e286.
doi: 10.4244/EIJY21M05_01.

Joint EAPCI/ACVC expert consensus document on percutaneous ventricular assist devices

Alaide Chieffo  1 , Dariusz Dudek, Christian Hassager, Alain Combes, Mario Gramegna, Sigrun Halvorsen, Kurt Huber, Vijay Kunadian, Jiri Maly, Jacob Eifer Møller, Federico Pappalardo, Giuseppe Tarantini, Guido Tavazzi, Holger Thiele, Christophe Vandenbriele, Nicolas Van Mieghem, Pascal Vranckx, Nikos Werner, Susanna Price
Affiliations

Joint EAPCI/ACVC expert consensus document on percutaneous ventricular assist devices

Alaide Chieffo et al. EuroIntervention. .

Abstract

There has been a significant increase in the use of short-term percutaneous ventricular assist devices (pVADs) as acute circulatory support in cardiogenic shock and to provide haemodynamic support during interventional procedures, including high-risk percutaneous coronary interventions. Although frequently considered together, pVADs differ in their haemodynamic effects, management, indications, insertion techniques, and monitoring requirements. This consensus document summarizes the views of an expert panel by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and the Association for Acute Cardiovascular Care (ACVC) and appraises the value of short-term pVAD. It reviews the pathophysiological context and possible indications for pVAD in different clinical settings and provides guidance regarding the management of pVAD based on existing evidence and best current practice.

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Conflict of interest statement

A. Chieffo received consulting fees/honoraria from Abiomed, Abbott Vascular, Cardinal Health, Biosensor, Magenta Medical. D. Dudek has served on the Scientific Advisory Board of Impella CP. A. Combes received grants and personal fees from Getinge. J. E. Møller received grants and personal fees from Abiomed and personal fees from Orion Pharma and Novartis. F. Pappalardo received personal fees from Abiomed. G. Tarantini received personal fees from Abiomed and GADA. G. Tavazzi received personal fees from GE Healthcare. N. van Mieghem received grants and personal fees from Abbott Vascular, Medtronic, Boston Scientific, PulseCath BV. N. Werner received personal fees and non-financial support from Abiomed. None of the other authors has relevant conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Pressure-volume loops. (A) Normal PV-loop and PV-loop in acute cardiogenic shock, the slope (Ees) shifts with changes in contractility. (B) PV-loop in VA-ECMO supported cardiogenic shock. PV-loop becomes narrower and is associated with an increase in EDPVR. (C) PV-loop in a left ventricular microaxial flow pump supported configuration, resulting in loss of normal isovolumetric periods, reduced EDPVR and conversion of the typical PV-loop to a triangular shape. Ea: arterial elastance; EDPVR: end-diastolic pressure-volume relationship; EDPVR: end-diastolic pressure-volume relationship; EDV: end-diastolic volume; Ees: end-systolic elastance; ESPVR: end-systolic pressure-volume relationship; ESV: end-systolic volume
Figure 2
Figure 2
Different options for pVAD. Arrows indicate which part of the circulation is supported by the pVAD-modality. Devices in green can add blood oxygenation next to mechanical support. IABP: intra-aortic balloon pump; VA-ECMO: veno-arterial extracorporeal membrane oxygenation
Figure 3
Figure 3
Complications associated with pVAD. Most frequent complications associated with pVADs depending on timepoint of implantation and weaning. *Indicates problems like bleeding, leg ischaemia, dissection or pseudoaneurysm; **Indicates problems as Harlequin-syndrome, cannula dislocation, afterload and/or preload mismatch. ICU: intensive care unit; SIRS: systemic inflammatory response syndrome
Figure 4
Figure 4
Algorithm for pVAD weaning in cardiogenic shock. MCS: mechanical circulatory support; PCWP: pulmonary capillary wedge pressure
See this image and copyright information in PMC

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