Temporary Mechanical Circulatory Support in Acute Heart Failure

Federica Jiritano; Valeria Lo Coco; Matteo Matteucci; Dario Fina; Anne Willers; Roberto Lorusso

doi:10.15420/cfr.2019.02

Temporary Mechanical Circulatory Support in Acute Heart Failure

Card Fail Rev. 2020 Mar 16:6:e01. doi: 10.15420/cfr.2019.02. eCollection 2020 Mar.

Authors

Federica Jiritano^{1

2}, Valeria Lo Coco¹, Matteo Matteucci^{1

3}, Dario Fina^{1

4}, Anne Willers¹, Roberto Lorusso¹

Affiliations

¹ Cardiothoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht Maastricht, the Netherlands.
² Cardiac Surgery Unit, University Magna Graecia of Catanzaro Catanzaro, Italy.
³ Department of Cardiac Surgery, Circolo Hospital, University of Insubria Varese, Italy.
⁴ University of Milan, IRCCS Policlinico San Donato Milan, Italy.

Abstract

Cardiogenic shock (CS) is a challenging syndrome, associated with significant morbidity and mortality. Although pharmacological therapies are successful and can successfully control this acute cardiac illness, some patients remain refractory to drugs. Therefore, a more aggressive treatment strategy is needed. Temporary mechanical circulatory support (TCS) can be used to stabilise patients with decompensated heart failure. In the last two decades, the increased use of TCS has led to several kinds of devices becoming available. However, indications for TCS and device selection are part of a complex process. It is necessary to evaluate the severity of CS, any early and prompt haemodynamic resuscitation, prior TCS, specific patient risk factors, technical limitations and adequacy of resources and training, as well as an assessment of whether care would be futile. This article examines options for commonly used TCS devices, including intra-aortic balloon pumps, a pulsatile percutaneous ventricular assist device (the iVAC), veno-arterial extra-corporeal membrane oxygenation and Impella (Abiomed) and TandemHeart (LivaNova) percutaneous ventricular assist device.

Keywords: Temporary mechanical circulation; acute heart failure; extra-corporeal membrane oxygenation; intra-aortic balloon pump; left ventricular assist device.

Publication types

Review