The New Era of Cardiogenic Shock: Progress in Mechanical Circulatory Support
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CARDIOGENIC SHOCK: PROGRESS IN MECHANICAL CIRCULATORY SUPPORT (JE RAME, SECTION EDITOR)
The New Era of Cardiogenic Shock: Progress in Mechanical Circulatory Support Ahmed Seliem 1 & Shelley A. Hall 1,2,3 Accepted: 8 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review In recent decades, multiple left and right ventricular assist devices (VAD) have been developed, and the utilization of these devices has grown exponentially. We discuss the most common temporary mechanical circulatory support (tMCS) devices used for patients in cardiogenic shock, including the intra-aortic balloon pump (IABP), transvalvular axial flow support systems (Impella®), the Tandem™ collection, and extracorporeal membrane oxygenation (ECMO). Recent Findings In 2018 the United Network for Organ Sharing (UNOS) introduced new listing criteria for candidates awaiting heart transplantation in the USA. Analysis of the first 1300 transplants under these new listing criteria has shown that higher-risk patients are now undergoing transplantation. Summary As technology has advanced, becoming more sophisticated and miniaturized, a new era has emerged with more rapidly deployable tMCS devices. For some patients presenting in cardiogenic shock, support with these tMCS devices can be a bridge to a more durable option. For others, their only option may be support with the hope of native cardiac recovery. Understanding the pros and cons of each device can lead to most appropriate utilization for the ultimate intended goal. Keywords IABP . Temporary mechanical support . Cardiogenic shock . ECMO . Impella . Ventricular assist device
Abbreviations IABP Intra-aortic balloon pump ECMO Extracorporeal membrane oxygenation This article is part of Topical Collection on Cardiogenic Shock: Progress in Mechanical Circulatory Support
tMCS LV VAD CS PCI AMI
Temporary mechanical support Left ventricle Ventricular assist device Cardiogenic shock Percutaneous coronary intervention Acute myocardial infarction
* Ahmed Seliem [email protected]
Introduction 1
Center for Advanced Heart and Lung Diseases, Baylor University Medical Center, 3410 Worth Street, Suite 250, Dallas, TX 75246, USA
2
Division of Cardiology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, TX, USA
3
Texas A&M University Health Science Center College of Medicine, Dallas, TX, USA
Cardiogenic shock can present as isolated right, left, or combined biventricular heart failure. The majority of patients presenting in cardiogenic shock are those with decompensated dilated or ischemic cardiomyopathy; the most studied are those who present with an acute myocardial infarction (AMI). Temporary mechanical circulatory support in these
Curr Heart Fail Rep
patients can be used to preserve end organ function and allow time to assess prognosis and guide definitive treatment. Multiple left and right ventricular tMCS devices exist. The technology has advanced to be more rapidly deployable, miniaturized and placed percutaneously while
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