Mechanical Circulatory Support: A Clinical Reality

Abstract

Mechanical circulatory support is becoming an alternative therapeutic option for patients in cardiogenic shock or advanced cardiac failure who cannot be improved by maximal medical therapy. More than 30 years of engineering development and clinical research have led to a level of efficacy and reliability of ventricular assist devices, which allows promotion of this approach for the most difficult patients. Uses include a gaining-time strategy as a bridge to cardiac transplantation or recovery of native cardiac function, as well as permanent support with the device. The large variety of devices permits every cardiac surgical unit, even those not used to cardiac transplantation, to propose this option to the patient. Recent experience with small silent implantable pumps suggests that the pioneering period of mechanical circulatory support is probably over, and the time has come for precise prospective trials to optimize both patient selection and the timing for utilization. In countries where cardiac transplantation has not developed, there is now an easily accessible technique for management of patients with cardiac failure.

Integrated management of cardiac failure: the cardiac failure clinic

“…The impact of the environment on the outcome of cell grafting into the myocardium of cell injection into the coronary circulation has been recognized. Adjusting this environment by mechanical circulatory assistance is, theoretically, a new route for development which deserves specific study protocols: we may expect that the chances for a rapid recovery of the native myocardial function will be enhanced by a combined therapy including left ventricular unloading, support to the peripheral circulation by mechanical assist systems and specific cell/gene therapy [9]. This comment supports strongly the concerted action of a variety of different experts within an identified structure.…”

Development of a Hybrid Decision Support Model for Optimal Ventricular Assist Device Weaning

“…For a growing number of patients with advanced or refractory cardiac disease, VAD therapy has demonstrated the potential to extend life, improve the quality of remaining life [3-6], and even lead to cardiac recovery [7-8]. Following the first report of VAD weaning in 1995 [9], numerous centers have demonstrated the prospect of cardiac recovery for a subset of VAD patients, including University of Pittsburgh Medical Center (UPMC), Texas Heart Institute, Berlin Heart Center, Columbia Presbyterian, Toronto General Hospital, and others.…”