Advancements in mechanical circulatory support for patients in acute and chronic heart failure

Thomas A. Csepe, Ahmet Kilic

Research output: Contribution to journalReview article

Abstract

Cardiogenic shock (CS) continues to have high mortality and morbidity despite advances in pharmacological, mechanical, and reperfusion approaches to treatment. When CS is refractory to medical therapy, percutaneous mechanical circulatory support (MCS) should be considered. Acute MCS devices, ranging from intra-aortic balloon pumps (IABPs) to percutaneous temporary ventricular assist devices (VAD) to extracorporeal membrane oxygenation (ECMO), can aid, restore, or maintain appropriate tissue perfusion before the development of irreversible end-organ damage. Technology has improved patient survival to recovery from CS, but in patients whom cardiac recovery does not occur, acute MCS can be effectively utilized as a bridge to long-term MCS devices and/or heart transplantation. Heart transplantation has been limited by donor heart availability, leading to a greater role of left ventricular assist device (LVAD) support. In patients with biventricular failure that are ineligible for LVAD implantation, further advancements in the total artificial heart (TAH) may allow for improved survival compared to medical therapy alone. In this review, we discuss the current state of acute and durable MCS, ongoing advances in LVADs and TAH devices, improved methods of durable MCS implantation and patient selection, and future MCS developments in this dynamic field that may allow for optimization of HF treatment.

Original languageEnglish (US)
Pages (from-to)4070-4083
Number of pages14
JournalJournal of Thoracic Disease
Volume9
Issue number10
DOIs
StatePublished - Oct 1 2017
Externally publishedYes

Fingerprint

Heart-Assist Devices
Cardiogenic Shock
Heart Failure
Artificial Heart
Heart Transplantation
Equipment and Supplies
Extracorporeal Membrane Oxygenation
Survival
Therapeutics
Patient Selection
Reperfusion
Perfusion
Tissue Donors
Pharmacology
Technology
Morbidity
Mortality

Keywords

  • Cardiogenic shock (CS)
  • Heart failure
  • Left ventricular assist device (LVAD)
  • Mechanical circulatory support (MCS)

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Advancements in mechanical circulatory support for patients in acute and chronic heart failure. / Csepe, Thomas A.; Kilic, Ahmet.

In: Journal of Thoracic Disease, Vol. 9, No. 10, 01.10.2017, p. 4070-4083.

Research output: Contribution to journalReview article

@article{e2e5df59a78f435fb0e4fc73151ff995,
title = "Advancements in mechanical circulatory support for patients in acute and chronic heart failure",
abstract = "Cardiogenic shock (CS) continues to have high mortality and morbidity despite advances in pharmacological, mechanical, and reperfusion approaches to treatment. When CS is refractory to medical therapy, percutaneous mechanical circulatory support (MCS) should be considered. Acute MCS devices, ranging from intra-aortic balloon pumps (IABPs) to percutaneous temporary ventricular assist devices (VAD) to extracorporeal membrane oxygenation (ECMO), can aid, restore, or maintain appropriate tissue perfusion before the development of irreversible end-organ damage. Technology has improved patient survival to recovery from CS, but in patients whom cardiac recovery does not occur, acute MCS can be effectively utilized as a bridge to long-term MCS devices and/or heart transplantation. Heart transplantation has been limited by donor heart availability, leading to a greater role of left ventricular assist device (LVAD) support. In patients with biventricular failure that are ineligible for LVAD implantation, further advancements in the total artificial heart (TAH) may allow for improved survival compared to medical therapy alone. In this review, we discuss the current state of acute and durable MCS, ongoing advances in LVADs and TAH devices, improved methods of durable MCS implantation and patient selection, and future MCS developments in this dynamic field that may allow for optimization of HF treatment.",
keywords = "Cardiogenic shock (CS), Heart failure, Left ventricular assist device (LVAD), Mechanical circulatory support (MCS)",
author = "Csepe, {Thomas A.} and Ahmet Kilic",
year = "2017",
month = "10",
day = "1",
doi = "10.21037/jtd.2017.09.89",
language = "English (US)",
volume = "9",
pages = "4070--4083",
journal = "Journal of Thoracic Disease",
issn = "2072-1439",
publisher = "Pioneer Bioscience Publishing Company (PBPC)",
number = "10",

}

TY - JOUR

T1 - Advancements in mechanical circulatory support for patients in acute and chronic heart failure

AU - Csepe, Thomas A.

AU - Kilic, Ahmet

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Cardiogenic shock (CS) continues to have high mortality and morbidity despite advances in pharmacological, mechanical, and reperfusion approaches to treatment. When CS is refractory to medical therapy, percutaneous mechanical circulatory support (MCS) should be considered. Acute MCS devices, ranging from intra-aortic balloon pumps (IABPs) to percutaneous temporary ventricular assist devices (VAD) to extracorporeal membrane oxygenation (ECMO), can aid, restore, or maintain appropriate tissue perfusion before the development of irreversible end-organ damage. Technology has improved patient survival to recovery from CS, but in patients whom cardiac recovery does not occur, acute MCS can be effectively utilized as a bridge to long-term MCS devices and/or heart transplantation. Heart transplantation has been limited by donor heart availability, leading to a greater role of left ventricular assist device (LVAD) support. In patients with biventricular failure that are ineligible for LVAD implantation, further advancements in the total artificial heart (TAH) may allow for improved survival compared to medical therapy alone. In this review, we discuss the current state of acute and durable MCS, ongoing advances in LVADs and TAH devices, improved methods of durable MCS implantation and patient selection, and future MCS developments in this dynamic field that may allow for optimization of HF treatment.

AB - Cardiogenic shock (CS) continues to have high mortality and morbidity despite advances in pharmacological, mechanical, and reperfusion approaches to treatment. When CS is refractory to medical therapy, percutaneous mechanical circulatory support (MCS) should be considered. Acute MCS devices, ranging from intra-aortic balloon pumps (IABPs) to percutaneous temporary ventricular assist devices (VAD) to extracorporeal membrane oxygenation (ECMO), can aid, restore, or maintain appropriate tissue perfusion before the development of irreversible end-organ damage. Technology has improved patient survival to recovery from CS, but in patients whom cardiac recovery does not occur, acute MCS can be effectively utilized as a bridge to long-term MCS devices and/or heart transplantation. Heart transplantation has been limited by donor heart availability, leading to a greater role of left ventricular assist device (LVAD) support. In patients with biventricular failure that are ineligible for LVAD implantation, further advancements in the total artificial heart (TAH) may allow for improved survival compared to medical therapy alone. In this review, we discuss the current state of acute and durable MCS, ongoing advances in LVADs and TAH devices, improved methods of durable MCS implantation and patient selection, and future MCS developments in this dynamic field that may allow for optimization of HF treatment.

KW - Cardiogenic shock (CS)

KW - Heart failure

KW - Left ventricular assist device (LVAD)

KW - Mechanical circulatory support (MCS)

UR - http://www.scopus.com/inward/record.url?scp=85036586052&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85036586052&partnerID=8YFLogxK

U2 - 10.21037/jtd.2017.09.89

DO - 10.21037/jtd.2017.09.89

M3 - Review article

C2 - 29268418

AN - SCOPUS:85036586052

VL - 9

SP - 4070

EP - 4083

JO - Journal of Thoracic Disease

JF - Journal of Thoracic Disease

SN - 2072-1439

IS - 10

ER -