Short-term mechanical circulatory assist devices
- Julian M Aroesty, MD
Julian M Aroesty, MD
- Clinical Associate Professor of Medicine
- Harvard Medical School
- Valluvan Jeevanandam, MD
Valluvan Jeevanandam, MD
- Chief, Cardiac & Thoracic Surgery
- Professor of Surgery
- The University of Chicago Medicine and Biological Sciences
- Howard J Eisen, MD
Howard J Eisen, MD
- Thomas J Vischer Professor of Medicine
- Drexel University College of Medicine
Short-term mechanical circulatory assist (support) devices are designed to be used for a wide range of clinical conditions ranging from prophylactic insertion for high-risk invasive coronary artery procedures to the management of cardiogenic shock, acute decompensated heart failure, or cardiopulmonary arrest. These devices are often placed in the catheterization laboratory but in some cases, such as an intraaortic balloon pump, can be placed in intensive care unit.
There are four major (arbitrary) categories of circulatory assist devices: intra-aortic balloon pump (IABP), non-IABP percutaneous mechanical circulatory assist devices (image 1), extracorporeal membrane oxygenator pumps, and nonpercutaneous centrifugal pumps, which are used for cardiopulmonary bypass.
A description of the short-term circulatory assist devices will be reviewed here. The clinical indications for these devices are discussed separately. (See 'Indications' below.)
The role for intermediate- and long-term mechanical circulatory devices as "bridges" to transplantation or as replacement therapy for failing hearts is discussed separately. (See "Intermediate- and long-term mechanical circulatory support".)
MECHANISM OF BENEFIT
While each device discussed below has a different design and operation, the following parameters of circulatory function are improved by all devices; the degree of improvement varies between devices and patients :
- Rihal CS, Naidu SS, Givertz MM, et al. 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care: Endorsed by the American Heart Assocation, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention. J Am Coll Cardiol 2015; 65:e7.
- Siegenthaler MP, Brehm K, Strecker T, et al. The Impella Recover microaxial left ventricular assist device reduces mortality for postcardiotomy failure: a three-center experience. J Thorac Cardiovasc Surg 2004; 127:812.
- Jurmann MJ, Siniawski H, Erb M, et al. Initial experience with miniature axial flow ventricular assist devices for postcardiotomy heart failure. Ann Thorac Surg 2004; 77:1642.
- O'Neill WW, Kleiman NS, Moses J, et al. A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation 2012; 126:1717.
- Basra SS, Loyalka P, Kar B. Current status of percutaneous ventricular assist devices for cardiogenic shock. Curr Opin Cardiol 2011; 26:548.
- Thiele H, Lauer B, Hambrecht R, et al. Reversal of cardiogenic shock by percutaneous left atrial-to-femoral arterial bypass assistance. Circulation 2001; 104:2917.
- Thiele H, Sick P, Boudriot E, et al. Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J 2005; 26:1276.
- Kar B, Gregoric ID, Basra SS, et al. The percutaneous ventricular assist device in severe refractory cardiogenic shock. J Am Coll Cardiol 2011; 57:688.
- Hernandez AF, Grab JD, Gammie JS, et al. A decade of short-term outcomes in post cardiac surgery ventricular assist device implantation: data from the Society of Thoracic Surgeons' National Cardiac Database. Circulation 2007; 116:606.
- Hernandez AF, Shea AM, Milano CA, et al. Long-term outcomes and costs of ventricular assist devices among Medicare beneficiaries. JAMA 2008; 300:2398.
- Simon D, Fischer S, Grossman A, et al. Left ventricular assist device-related infection: treatment and outcome. Clin Infect Dis 2005; 40:1108.
- Herrmann M, Weyand M, Greshake B, et al. Left ventricular assist device infection is associated with increased mortality but is not a contraindication to transplantation. Circulation 1997; 95:814.
- Deng MC, Erren M, Tjan TD, et al. Left ventricular assist system support is associated with persistent inflammation and temporary immunosuppression. Thorac Cardiovasc Surg 1999; 47 Suppl 2:326.
- Reilly MP, Wiegers SE, Cucchiara AJ, et al. Frequency, risk factors, and clinical outcomes of left ventricular assist device-associated ventricular thrombus. Am J Cardiol 2000; 86:1156.
- Vogel RA, Shawl F, Tommaso C, et al. Initial report of the National Registry of Elective Cardiopulmonary Bypass Supported Coronary Angioplasty. J Am Coll Cardiol 1990; 15:23.
- Kato S, Morimoto S, Hiramitsu S, et al. Use of percutaneous cardiopulmonary support of patients with fulminant myocarditis and cardiogenic shock for improving prognosis. Am J Cardiol 1999; 83:623.
- MECHANISM OF BENEFIT
- NON-IABP PERCUTANEOUS CIRCULATORY DEVICES
- Left ventricle to aorta assist devices
- Left atrial to aorta assist devices
- Other limitations
- EXTRACORPOREAL MEMBRANE OXYGENATION
- NONPERCUTANEOUS CENTRIFUGAL PUMPS