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Review
. 2022 Mar 4;16(1):37-48.
doi: 10.17925/HI.2022.16.1.37. eCollection 2022.

A Comprehensive Review of Mechanical Circulatory Support Devices

Varunsiri Atti  1 , Mahesh Anantha Narayanan  2 , Brijesh Patel  1 , Sudarshan Balla  1 , Aleem Siddique  3 , Scott Lundgren  4 , Poonam Velagapudi  4
Affiliations
Review

A Comprehensive Review of Mechanical Circulatory Support Devices

Varunsiri Atti et al. Heart Int. .

Abstract

Treatment strategies to combat cardiogenic shock (CS) have remained stagnant over the past decade. Mortality rates among patients who suffer CS after acute myocardial infarction (AMI) remain high at 50%. Mechanical circulatory support (MCS) devices have evolved as novel treatment strategies to restore systemic perfusion to allow cardiac recovery in the short term, or as durable support devices in refractory heart failure in the long term. Haemodynamic parameters derived from right heart catheterization assist in the selection of an appropriate MCS device and escalation of mechanical support where needed. Evidence favouring the use of one MCS device over another is scant. An intra-aortic balloon pump is the most commonly used short-term MCS device, despite providing only modest haemodynamic support. Impella CP® has been increasingly used for CS in recent times and remains an important focus of research for patients with AMI-CS. Among durable devices, Heartmate® 3 is the most widely used in the USA. Adequately powered randomized controlled trials are needed to compare these MCS devices and to guide the operator for their use in CS. This article provides a brief overview of the types of currently available MCS devices and the indications for their use.

Keywords: Cardiogenic shock; haemodynamic monitoring; mechanical circulatory support.

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Conflict of interest statement

Disclosures: Varunsiri Atti, Mahesh Anantha Narayanan, Brijesh Patel, Sudarshan Balla and Aleem Siddique have no financial or non-financial relationships or activities to declare in relation to this article. Scott Lundgren participated on the speaker's bureau for Abbott. Poonam Velagapudi is on the advisory board and participated on the speaker's bureau for Abiomed, and also participated on the speaker's bureau for Opsens.

Figures

Figure 1:
Figure 1:. Diagnosis and management of cardiogenic shock
Figure 2:
Figure 2:. Haemodynamic profiles in cardiogenic shock
Figure 3:
Figure 3:. Algorithm for escalation of temporary mechanical circulatory support
Figure 4:
Figure 4:. Pressure volume loop of Impella demonstrating increasing degree of left ventricular unloading with increased flow
Figure 5:
Figure 5:. Pressure volume loop of venoarterial extracorporeal membrane oxygenation demonstrating flow-dependent increase in end diastolic pressure with concomitant decrease in left ventricular stroke volume
Figure 6:
Figure 6:. Pressure volume loops of TandemHeart demonstrating flow-dependent increase in end systolic volume, decrease in stroke volume, and unloading the left ventricle by decrease in left ventricular end diastolic volume and pressure
See this image and copyright information in PMC

References

    1. van Diepen S, Katz JN, Albert NM. et al. Contemporary management of cardiogenic shock: A scientific statement from the American Heart Association. Circulation. 2017;136:e232–68. - PubMed
    1. Vahdatpour C, Collins D, Goldberg S. Cardiogenic shock. J Am Heart Assoc. 2019;8:e011991. - PMC - PubMed
    1. Werdan K, Gielen S, Ebelt H. et al. Mechanical circulatory support in cardiogenic shock. Eur Heart J. 2014;35:156–67. - PubMed
    1. Kirklin JK, Naftel DC, Pagani FD. et al. Seventh INTERMACS annual report: 15,000 patients and counting. J Heart Lung Transplant. 2015;34:1495–504. - PubMed
    1. Amin AP, Spertus JA, Curtis JP. et al. The evolving landscape of Impella use in the United States among patients undergoing percutaneous coronary intervention with mechanical circulatory support. Circulation. 2020;141:273–84. - PubMed

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