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. 2021 Jun 30;10(5):570-583.
doi: 10.1093/ehjacc/zuab015.

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

Alaide Chieffo  1 , Dariusz Dudek  2 , Christian Hassager  3 , Alain Combes  4 , Mario Gramegna  5 , Sigrun Halvorsen  6 , Kurt Huber  7 , Vijay Kunadian  8 , Jiri Maly  9 , Jacob Eifer Møller  10 , Federico Pappalardo  11 , Giuseppe Tarantini  12 , Guido Tavazzi  13 , Holger Thiele  14 , Christophe Vandenbriele  15   16 , Nicolas van Mieghem  17 , Pascal Vranckx  18 , Nikos Werner  19 , Susanna Price  16
Affiliations

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

Alaide Chieffo et al. Eur Heart J Acute Cardiovasc Care. .

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.

Keywords: Acute coronary syndromes; ECMO; High-risk percutaneous coronary intervention; Impella; Intra-aortic balloon pump; Mechanical circulatory support.

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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. ICU: intensive care unit; SIRS: systemic inflammatory response syndrome. *Indicates problems like bleeding, leg ischaemia, dissection or pseudoaneurysm; **Indicates problems as Harlequin-syndrome, cannula dislocation, afterload and/or preload mismatch.
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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