Keywords

Intro to Support Devices

Mechanical circulatory support (MCS) devices are designed to support patients, while they are acutely decompensated, or to support them through high-risk procedures to prevent decompensation. MCS devices are designed to augment vasopressor and inotrope therapy as a way to decrease preload, afterload, and oxygen consumption by the heart. Long-term mechanical support devices are also available and are used as a bridge to transplantation, bridge to decision, destination therapy, or bridge to recovery.

There are several MCS options, each with varying evidence supporting their use (Table 25.1). MCS devices can be placed surgically or percutaneously. The main MCS devices used today include intra-aortic balloon pump (IABP), percutaneous ventricular assist device (pVAD), extracorporeal membrane oxygenation (ECMO), and implanted ventricular assist devices (VAD).

Table 25.1 MCS devices, their level of support, mechanism of action, and helpful information for each
Full size table

Complications include death, infection, limb ischemia, embolic events, bleeding, hemolysis, and malposition [1]. These complications may be worsened depending on patient comorbidities. Careful patient selection for MCS is warranted. Each patient should undergo a robust multidisciplinary evaluation to determine candidacy if able. It is also recommended that prompt evaluation by the MCS team should be made in patients with CS to facilitate recovery [1].