Temporary Circulatory Support With Ventricular Assist Devices: Update on Surgical and Percutaneous Strategies
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CARDIOGENIC SHOCK: PROGRESS IN MECHANICAL CIRCULATORY SUPPORT (JE RAME, SECTION EDITOR)
Temporary Circulatory Support With Ventricular Assist Devices: Update on Surgical and Percutaneous Strategies Enrique Gongora 1 & Erik Orozco 1 & Charles Hoopes 1 Accepted: 8 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The available platforms for temporary circulatory support (TCS) have expanded to include impeller technologies in addition to the traditional approaches with centrifugal pumps and intra-aortic counterpulsation. We review the evidence for competing technologies, relative risk, and benefit of individual TCS platforms and provide a consensus opinion in the context of our institutional experience. Recent Findings Trans-aortic axial flow devices (Impella) have significantly impacted the support of patients with cardiogenic shock. Despite the absence of prospective randomized data, the use of both percutaneous and surgical Impella devices is ubiquitous among heart failure centers and rapidly evolving. Extracorporeal centrifugal pumps remain the technology of last resort. Summary Despite the increasing use of new TCS platforms, there is little empirical evidence that outcomes have been impacted. Increasingly, systems of care—rather than technology—are seen as the more important variable in the management of patients with cardiogenic shock. Keywords Cardiogenic shock . Impella . ECMO . Temporary circulatory support
Introduction Temporary mechanical circulatory support (MCS) has expanded over the past decade in response to evolving technologies and increased recognition of the role of mechanical support in disrupting the progressive end organ injury common to patients in cardiogenic shock. Here, we discuss the current mechanical platforms focusing on areas of controversy as it relates to application (e.g., why do we do it) and deployment (e.g., how and when do we do it). We begin with a brief review of the rapidly expanding impeller platforms (Impella), discuss the role and limitations of traditional centrifugal pump technologies (ECMO/ECLS/TandemHeart), Topical Collection on Cardiogenic Shock: Progress in Mechanical Circulatory Support * Charles Hoopes [email protected] 1
Department of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
and finish with an examination of integrated models of multimodality mechanical circulatory support.
The Impella Platform: Devices, Indications, Contraindications, and Controversy The Impella platform is a family of endovascular microaxial rotary blood pumps which transit the aortic valve apparatus, continuously drawing blood from the left ventricle and expelling into the aorta. There are currently five Impella left ventricular assist devices, Impella 2.5, Impella CP, Impella 5.0, Impella LD, and Impella 5.5, and one right ventricular assist device, the Impella RP. At present, the Impella ventricular support systems have been FDA approved for two separate indications: [1] temporary (< 6 h)
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