Mechanical circulatory supports – basic principles and clinical evidence
Authors:
Goncalvesová E.
Authors‘ workplace:
Národný ústav srdcových a cievnych chorôb, Bratislava
; Oddelenie pre zlyhávanie a transplantáciu srdca, Kardiologická klinika LF UK a NUSCH, Bratislava
Published in:
Kardiol Rev Int Med 2019, 21(2): 78-85
Overview
Severe heart failure with signs of cardiogenic shock, whether in cases of acute myocardial lesion or in the context of chronic heart failure, is a syndrome with a very poor prognosis. The only solution today is the use of a device that takes over the heart’s function. Mechanical circulatory supports are devices designed in a variety of ways to support or replace heart function as pumps, to a greater or lesser extent, for a longer or shorter period of time. In acute conditions, short-term support is being used to create a setting for myocardial recovery and/or a decision on further treatment. In highly selected patients with terminal chronic heart failure, the implantation of a long-term left ventricular assist device for bridging to heart transplantation or as a definitive treatment solution of left ventricular failure is usually indicated. The article provides a brief overview of the basic principles and results of the use of both short- and long-term mechanical circulatory support.
Keywords:
mechanical circulatory supports – classification – indications – durable devices
Sources
1. Studenčan M, Jesenský T, Notovný R et al. Perkutánna mechanická podpora obehu u 21-ročnej ženy s kardiogénnym šokom. Cardiol 2008; 17(2): 86–89.
2. Pacák J, Fridrich V, Zelenay J et al. Perkutánny dočasný mechanický ľavokomorový podporný obeh Impella Recover LP 2. 5. pri rizikovej perkutánnej koronárnej intervencii. Opis prvej skúsenosti na Slovensku. Cardiol 2007; 16(4): 172–176.
3. Werdan K, Gielen S, Ebelt H et al. Mechanical circulatory support in cardiogenic shock. Eur Heart J 2014; 35(3): 156–167. doi: 10.1093/ eurheartj/ eht248.
4. Unverzagt S, Machemer MT, Solms A et al. Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock. Cochrane Database Syst Rev 2011; (7): CD007398. doi: 10.1002/ 14651858.CD007398.pub2.
5. de Waha S, Desch S, Eitel I et al. What is the evidence for IABP in STEMI with and without cardiogenic shock? Ther Adv Cardiovasc Dis 2012; 6(3): 123–132. doi: 10.1177/ 1753944712446669.
6. Sjauw KD, Engstrom AE, Vis MM et al. A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines? Eur Heart J 2009; 30(4): 459–468. doi: 10.1093/ eurheartj/ ehn602.
7. Thiele H, Zeymer U, Neumann FJ et al. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet 2013; 382(9905): 1638–1645. doi: 10.1016/ S0140-6736(13)61783-3.
8. Lemaire A, Anderson MB, Lee LY et al. The Impella device for acute mechanical circulatory support in patients in cardiogenic shock. Ann Thorac Surg 2014; 97(1): 133–138. doi: 10.1016/ j.athoracsur.2013.07.053.
9. Dangas GD, Kini AS, Sharma SK et al. Impact of hemodynamic support with Impella 2. 5 versus intra-aortic balloon pump on prognostically important clinical outcomes in patients undergoing high-risk percutaneous coronary intervention (from the PROTECT II randomized trial). Am J cardiol 2014; 113(2): 222–228. doi: 10.1016/ j.amjcard.2013.09.008.
10. Flaherty MP, Pant S, Patel SV et al. Hemodynamic support with a microaxial percutaneous left ventricular assist device (Impella) protects against acute kidney injury in patients undergoing high-risk percutaneous coronary intervention. Circ Res 2017; 120(4): 692–700. doi: 10.1161/ CIRCRESAHA.116.309738.
11. Ouweneel DM, Eriksen E, Sjauw KD et al. Percutaneous mechanical circulatory support versus intra-aortic balloon pump in cardiogenic shock after acute myocardial infarction. J Am Coll Cardiol 2017; 69(3): 278–287. doi: 10.1016/ j.jacc.2016.10.022.
12. Ošťádal P, Bělohlávek J. ECMO – Extrakorporální membránová oxidace. 1. vyd. Praha: Maxdorf 2013.
13. Nagpal AD, Singal RK, Arora RC et al. Temporary mechanical circulatory support in cardiac critical care: a state of the art review and algorithm for device selection. Can J Cardiol 2017; 33(1): 110–118. doi: 10.1016/ j.cjca.2016.10.023.
14. Lee S, Fukamachi K, Golding L et al. Left ventricular assist devices: from the bench to the clinic. Cardiology 2013; 125(1): 1–12. doi: 10.1159/ 000346
865.
15. Goncalvesová E, Hulman M, Olejárová I et al. Iniciálne skúsenosti s implantabilnými mechanickými podporami ľavej komory v programe transplantácie srdca v Národnom ústave srdcových a cievnych chorôb. Cardiol 2008; 17(3): 101–108.
16. Birks EJ, George RS, Hedger M et al. Reversal of severe heart failure with a continuous-flow left ventricular assist device and pharmacological therapy: a prospective study. Circulation 2011; 123(4): 381–390. doi: 10.1161/ CIRCULATIONAHA.109.933960.
17. Rose EA, Gelijns AC, Moskowitz AJ et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med 2001; 345(20): 1435–1443. doi: 10.1056/ NEJMoa012175.
18. Miller LW, Pagani FD, Russell SD et al. Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med 2007; 357(9): 885–896. doi: 10.1056/ NEJMoa067758.
19. Pagani FD, Miller LW, Russell SD et al. Extended mechanical circulatory support with a continuous-flow rotary left ventricular assist device. J Am Coll Cardiol 2009; 54(4): 312–321. doi: 10.1016/ j.jacc.2009.03.055.
20. Slaughter MS, Rogers JG, Milano CA et al. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med 2009; 361(23): 2241–2251. doi: 10.1056/ NEJMoa0909938.
21. John R, Naka Y, Smedira NG et al. Continuous flow left ventricular assist device outcomes in commercial use compared with the prior clinical trial. Ann Thorac Surg 2011; 92(4): 1406–1413. doi: 10.1016/ j.athoracsur.2011.05.080.
22. Park SJ, Milano CA, Tatooles AJ et al. Outcomes in advanced heart failure patients with left ventricular assist devices for destination therapy. Circ Heart Fail 2012; 5(2): 241–248. doi: 10.1161/ CIRCHEARTFAILURE.111.963991.
23. Strüber M, Sander K, Lahpor J et al. HeartMate II left ventricular assist device; early European experience. Eur J Cardiothorac Surg 2008; 34(2): 289–294. doi: 10.1016/ j.ejcts.2008.05.011.
24. Aaronson KD, Slaughter MS, Miller LW et al. Use of an intrapericardial, continuous-flow, centrifugal pump in patients awaiting heart transplantation. Circulation 2012; 125(25): 3191–3200. doi: 10.1161/ CIRCULATIONAHA.111.058412.
25. Strueber M, O'Driscoll G, Jansz P et al. Multicenter evaluation of an intrapericardial left ventricular assist system. J Am Coll Cardiol 2011; 57(12): 1375–1382. doi: 10.1016/ j.jacc.2010.10.040.
26. Rogers JG, Aaronson KD, Boyle AJ et al. Continuous flow left ventricular assist device improves functional capacity and quality of life of advanced heart failure patients. J Am Coll Cardiol 2010; 55(17): 1826–1834. doi: 10.1016/ j.jacc.2009.12.052.
27. Mehra MR, Naka Y, Uriel N et al. A fully magnetically levitated circulatory pump for advanced heart failure. N Engl J Med 2017; 376(5): 440–450. doi: 10.1056/ NEJMoa1610426.
28. Kirklin JK, Naftel DC, Pagani DF et al. Seventh INTERMACS annual report: 15,000 patients and counting. J Heart Lung Transplant 2015; 34(12): 1495–1504. doi: 10.1016/ j.healun.2015.10.003.
29. Yourex-West H. TandemHeart’ helps make high-risk heart patients strong enough for surgery. Global News 2017. Available at: https:/ / globalnews.ca/ news/ 3369545/ tandemheart-helps-make-high-risk-heart-patients-strong-enough-for-surgery.
30. Takeda K, Garan AR, Ando M et al. Minimally invasive CentriMag ventricular assist device support integrated with extracorporeal membrane oxygenation in cardiogenic shock patients: a comparison with conventional CentriMag biventricular support configuration. Eur J Cardiothorac Surg 2017; 52(6): 1055–1061. doi:10.1093/ ejcts/ ezx189.
31. Casida J, Pagani FD, Aikens J. An evaluation of mobile care app as self-management tool in patients with left-ventricular assist devices. SSCD Center 2019. Available at: http:/ / www.socr.umich.edu/ CSCD/ html/ Projects/ PP1.html.
Labels
Paediatric cardiology Internal medicine Cardiac surgery CardiologyArticle was published in
Cardiology Review
![Issue 2](https://www.prolekare.cz/media/cache/resolve/journal_issue/media/image_pdf/4d5011044ae2b086c58794018e3e3936.jpeg)
2019 Issue 2
Most read in this issue
- Beta-blockers in cardiovascular diseases – Pros and Cons
- Update of the role of Lp(a) in determination of the CV risk and methods of influencing it
- Mechanical circulatory supports – basic principles and clinical evidence
- Safety and efficacy of new anticoagulants in real world clinical practice