Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
Current Heart Failure Reports
Published in: Current Heart Failure Reports 5/2017

01-10-2017 | Decompensated Heart Failure (P Banerjee, Section Editor)

Mechanical Circulatory Support for Decompensated Heart Failure

Authors: Tarique Al Musa, Colin Dominic Chue, Hoong Sern Lim

Published in: Current Heart Failure Reports | Issue 5/2017

Login to get access

Abstract

Purpose of Review

Cardiogenic shock from decompensated heart failure is associated with significant morbidity and mortality. Mechanical circulatory support (MCS) improves haemodynamics and reverses organ dysfunction in critically ill patients with cardiogenic shock. This paper summarises the main modalities of mechanical support and their physiological impact, practical considerations, advantages and disadvantages to facilitate a holistic approach in managing a potentially lethal pathology.

Recent Findings

To date, there remains a lack of large randomised controlled trials to support the use of any mechanical support strategy. Consequently, meta-analyses, registry data and expert consensus in the form of society guidelines are relied upon. Currently, randomised trials are in progress to assess the efficacy of a percutaneous assist device (Impella) and extracorporeal membrane oxygenation.

Summary

Mechanical support options are centred around the use of counter pulsation and percutaneous assist devices and the use of an extracorporeal pump and are hence varied in means of application, degree of haemodynamic benefit and potential complications. Regardless of future innovations, a timely multidisciplinary approach that incorporates both patient and institutional considerations will always be crucial to a successful outcome.
Literature
1.
2.
Reynolds HR, Hochman JS. Cardiogenic shock: current concepts and improving outcomes. Circulation. 2008;117(5):686–97.CrossRefPubMed
3.
Lim HS. Cardiogenic shock: failure of oxygen delivery and oxygen utilization. Clin Cardiol. 2016;39(8):477–83.CrossRefPubMed
4.
Stretch R, Sauer CM, Yuh DD, Bonde P. National trends in the utilization of short-term mechanical circulatory support: incidence, outcomes, and cost analysis. J Am Coll Cardiol. 2014;64(14):1407–15.CrossRefPubMed
5.
Werdan K, Gielen S, Ebelt H, Hochman JS. Mechanical circulatory support in cardiogenic shock. Eur Heart J. 2014;35(3):156–67.CrossRefPubMed
6.
Kantrowitz A, Tjonneland S, Freed PS, Phillips SJ, Butner AN, Sherman JL Jr. Initial clinical experience with intraaortic balloon pumping in cardiogenic shock. JAMA. 1968;203(2):113–8.CrossRefPubMed
7.
Subramanian VA, Goldstein JE, Sos TA, McCabe JC, Hoover EA, Gay WA Jr. Preliminary clinical experience with percutaneous intraaortic balloon pumping. Circulation. 1980;62(2 Pt 2):I123–9.PubMed
8.
Kapur NK, Esposito M. Hemodynamic support with percutaneous devices in patients with heart failure. Heart Fail Clin. 2015;11(2):215–30.CrossRefPubMed
9.
Estep JD, Cordero-Reyes AM, Bhimaraj A, Trachtenberg B, Khalil N, Loebe M, et al. Percutaneous placement of an intra-aortic balloon pump in the left axillary/subclavian position provides safe, ambulatory long-term support as bridge to heart transplantation. JACC Heart Fail. 2013;1(5):382–8.CrossRefPubMed
10.
Rihal CS, Naidu SS, Givertz MM, Szeto WY, Burke JA, Kapur NK, et al. 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care: endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d’intervention. J Am Coll Cardiol. 2015;65(19):e7–e26.CrossRefPubMed
11.
Pucher PH, Cummings IG, Shipolini AR, McCormack DJ. Is heparin needed for patients with an intra-aortic balloon pump? Interact Cardiovasc Thorac Surg. 2012;15(1):136–9.CrossRefPubMedPubMedCentral
12.
Gabauer I, Nosal’ova V, Okolicany J, Trnovec T, Styk J, Holec V. Distribution of cardiac output following 2 hours of intra-aortic balloon counterpulsation. Bratisl Lek Listy. 1980;73(1):26–35.PubMed
13.
Bonios MJ, Pierrakos CN, Argiriou M, Dalianis A, Terrovitis JV, Dolou P, et al. Increase in coronary blood flow by intra-aortic balloon counterpulsation in a porcine model of myocardial reperfusion. Int J Cardiol. 2010;138(3):253–60.CrossRefPubMed
14.
Nichols AB, Pohost GM, Gold HK, Leinbach RC, Beller GA, McKusick KA, et al. Left ventricular function during intra-aortic balloon pumping assessed by multigated cardiac blood pool imaging. Circulation. 1978;58(3 Pt 2):I176–83.PubMed
15.
Kern MJ, Aguirre F, Bach R, Donohue T, Siegel R, Segal J. Augmentation of coronary blood flow by intra-aortic balloon pumping in patients after coronary angioplasty. Circulation. 1993;87(2):500–11.CrossRefPubMed
16.
Weber KT, Janicki JS. Intraaortic balloon counterpulsation. A review of physiological principles, clinical results, and device safety. Ann Thorac Surg. 1974;17(6):602–36.CrossRefPubMed
17.
Aksoy O, Yousefzai R, Singh D, Agarwal S, O’Brien B, Griffin BP, et al. Cardiogenic shock in the setting of severe aortic stenosis: role of intra-aortic balloon pump support. Heart. 2011;97(10):838–43.CrossRefPubMed
18.
Parissis H, Graham V, Lampridis S, Lau M, Hooks G, Mhandu PC. IABP: history-evolution-pathophysiology-indications: what we need to know. J Cardiothorac Surg. 2016;11(1):122.CrossRefPubMedPubMedCentral
19.
Gu K, Chang Y, Gao B, Liu Y. Computational analysis of the effect of the control model of intraaorta pump on ventricular unloading and vessel response. ASAIO J. 2012;58(5):455–61.CrossRefPubMed
20.
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200.CrossRefPubMed
21.
Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med. 2012;367(14):1287–96.CrossRefPubMed
22.
Unverzagt S, Buerke M, de Waha A, Haerting J, Pietzner D, Seyfarth M, et al. Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock. Cochrane Database Syst Rev. 2015;(3):CD007398.
23.
American College of Emergency P, Society for Cardiovascular A, Interventions, O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(4):e78–140.CrossRef
24.
Basra SS, Loyalka P, Kar B. Current status of percutaneous ventricular assist devices for cardiogenic shock. Curr Opin Cardiol. 2011;26(6):548–54.CrossRefPubMed
25.
Mathur M, Hira RS, Smith BM, Lombardi WL, McCabe JM. Fully percutaneous technique for transaxillary implantation of the Impella CP. JACC Cardiovasc Intervent. 2016;9(11):1196–8.CrossRef
26.
Pappalardo F, Contri R, Pieri M, Colombo A, Zangrillo A. Fluoroless placement of Impella: a single center experience. Int J Cardiol. 2015;179:491–2.CrossRefPubMed
27.
Lauten A, Engstrom AE, Jung C, Empen K, Erne P, Cook S, et al. Percutaneous left-ventricular support with the Impella-2.5-assist device in acute cardiogenic shock: results of the Impella-EUROSHOCK-registry. Circ Heart Fail. 2013;6(1):23–30.CrossRefPubMed
28.
Ouweneel DM, Henriques JP. Percutaneous cardiac support devices for cardiogenic shock: current indications and recommendations. Heart. 2012;98(16):1246–54.CrossRefPubMed
29.
30.
Ergle K, Parto P, Krim SR. Percutaneous ventricular assist devices: a novel approach in the management of patients with acute cardiogenic shock. Ochsner J. 2016;16(3):243–9.PubMedPubMedCentral
31.
O’Neill WW, Kleiman NS, Moses J, Henriques JP, Dixon S, Massaro J, et al. A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation. 2012;126(14):1717–27.CrossRefPubMed
32.
Seyfarth M, Sibbing D, Bauer I, Frohlich G, Bott-Flugel L, Byrne R, et al. A randomized clinical trial to evaluate the safety and efficacy of a percutaneous left ventricular assist device versus intra-aortic balloon pumping for treatment of cardiogenic shock caused by myocardial infarction. J Am Coll Cardiol. 2008;52(19):1584–8.CrossRefPubMed
33.
Ouweneel DM, Eriksen E, Sjauw KD, van Dongen IM, Hirsch A, Packer EJ, 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):278–87.CrossRefPubMed
34.
Ouweneel DM, Eriksen E, Seyfarth M, Henriques JP. Percutaneous mechanical circulatory support versus intra-aortic balloon pump for treating cardiogenic shock: meta-analysis. J Am Coll Cardiol. 2017;69(3):358–60.CrossRefPubMed
35.
Anderson MB, Goldstein J, Milano C, Morris LD, Kormos RL, Bhama J, et al. Benefits of a novel percutaneous ventricular assist device for right heart failure: the prospective RECOVER RIGHT study of the Impella RP device. J Heart Lung Transplant. 2015;34(12):1549–60.CrossRefPubMed
36.
37.
Beckmann A, Benk C, Beyersdorf F, Haimerl G, Merkle F, Mestres C, et al. Position article for the use of extracorporeal life support in adult patients. Eur J Cardiothorac Surg: Off J Eur Assoc Cardiothorac Surg. 2011;40(3):676–80.
38.
Cheng R, Hachamovitch R, Kittleson M, Patel J, Arabia F, Moriguchi J, et al. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients. Ann Thorac Surg. 2014;97(2):610–6.CrossRefPubMed
39.
40.
• Lim HS, Howell N, Ranasinghe A. Extracorporeal life support: physiological concepts and clinical outcomes. J Card Fail. 2017. 23(2):181–96. A comprehensive review of ECLS physiology and contemporary clinical outcomes.
41.
Abrams D, Combes A, Brodie D. Extracorporeal membrane oxygenation in cardiopulmonary disease in adults. J Am Coll Cardiol. 2014;63(25 Pt A):2769–78.CrossRefPubMed
42.
Xie A, Phan K, Tsai YC, Yan TD, Forrest P. Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest: a meta-analysis. J Cardiothorac Vasc Anesth. 2015;29(3):637–45.CrossRefPubMed
43.
Cheng R, Hachamovitch R, Kittleson M, Patel J, Arabia F, Moriguchi J, et al. Clinical outcomes in fulminant myocarditis requiring extracorporeal membrane oxygenation: a weighted meta-analysis of 170 patients. J Card Fail. 2014;20(6):400–6.CrossRefPubMed
44.
Sern LH. Baseline MELD-XI score and outcome from veno-arterial extracorporeal membrane oxygenation support for acute decompensated heart failure. Eur Heart J Acute Cardiovasc Care. 2016;5(7):82–8.CrossRef
45.
• Schmidt M, Burrell A, Roberts L, Bailey M, Sheldrake J, Rycus PT, et al. Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J. 2015;36(33):2246–56. First risk prediction tool with VA-ECMO in cardiogenic shock. CrossRefPubMed
46.
Nagpal AD, Singal RK, Arora RC, Lamarche Y. 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):110–8.CrossRefPubMed
47.
Mohite PN, Zych B, Popov AF, Sabashnikov A, Saez DG, Patil NP, et al. CentriMag short-term ventricular assist as a bridge to solution in patients with advanced heart failure: use beyond 30 days. Eur J Cardiothorac Surg: Off J Eur Assoc Cardiothorac Surg. 2013;44(5):e310–5.CrossRef
48.
John R, Long JW, Massey HT, Griffith BP, Sun BC, Tector AJ, et al. Outcomes of a multicenter trial of the Levitronix CentriMag ventricular assist system for short-term circulatory support. J Thorac Cardiovasc Surg. 2011;141(4):932–9.CrossRefPubMed
49.
Takayama H, Soni L, Kalesan B, Truby LK, Ota T, Cedola S, et al. Bridge-to-decision therapy with a continuous-flow external ventricular assist device in refractory cardiogenic shock of various causes. Circ Heart Fail. 2014;7(5):799–806.CrossRefPubMedPubMedCentral
50.
Borisenko O, Wylie G, Payne J, Bjessmo S, Smith J, Yonan N, et al. Thoratec CentriMag for temporary treatment of refractory cardiogenic shock or severe cardiopulmonary insufficiency: a systematic literature review and meta-analysis of observational studies. ASAIO J. 2014;60(5):487–97.CrossRefPubMedPubMedCentral
51.
Lim HS, Howell N, Ranasinghe A. The physiology of continuous-flow left ventricular assist devices. J Card Fail. 2017;23(2):169–80.CrossRefPubMed
52.
McCarthy PM, Nakatani S, Vargo R, Kottke-Marchant K, Harasaki H, James KB, et al. Structural and left ventricular histologic changes after implantable LVAD insertion. Ann Thorac Surg. 1995;59(3):609–13.CrossRefPubMed
53.
Kutty RS, Parameshwar J, Lewis C, Catarino PA, Sudarshan CD, Jenkins DP, et al. Use of centrifugal left ventricular assist device as a bridge to candidacy in severe heart failure with secondary pulmonary hypertension. Eur J Cardiothorac Surg: Off J Eur Assoc Cardiothorac Surg. 2013;43(6):1237–42.CrossRef
54.
Holman WL, Bourge RC, Fan P, Kirklin JK, Pacifico AD, Nanda NC. Influence of left ventricular assist on valvular regurgitation. Circulation. 1993;88(5 Pt 2):II309–18.PubMed
55.
Kormos RL, Teuteberg JJ, Pagani FD, Russell SD, John R, Miller LW, et al. Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: incidence, risk factors, and effect on outcomes. J Thorac Cardiovasc Surg. 2010;139(5):1316–24.CrossRefPubMed
56.
Rose EA, Gelijns AC, Moskowitz AJ, Heitjan DF, Stevenson LW, Dembitsky W, et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 2001;345(20):1435–43.CrossRefPubMed
57.
Slaughter MS, Rogers JG, Milano CA, Russell SD, Conte JV, Feldman D, et al. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med. 2009;361(23):2241–51.CrossRefPubMed
58.
Jorde UP, Kushwaha SS, Tatooles AJ, Naka Y, Bhat G, Long JW, et al. Results of the destination therapy post-food and drug administration approval study with a continuous flow left ventricular assist device: a prospective study using the INTERMACS registry (Interagency Registry for Mechanically Assisted Circulatory Support). J Am Coll Cardiol. 2014;63(17):1751–7.CrossRefPubMed
59.
Kirkpatrick JN, Wieselthaler G, Strueber M, St John Sutton MG, Rame JE. Ventricular assist devices for treatment of acute heart failure and chronic heart failure. Heart. 2015;101(14):1091–6.CrossRefPubMed
60.
Estep JD, Starling RC, Horstmanshof DA, Milano CA, Selzman CH, Shah KB, et al. Risk assessment and comparative effectiveness of left ventricular assist device and medical management in ambulatory heart failure patients: results from the ROADMAP study. J Am Coll Cardiol. 2015;66(16):1747–61.CrossRefPubMed
61.
Tsukui H, Abla A, Teuteberg JJ, McNamara DM, Mathier MA, Cadaret LM, et al. Cerebrovascular accidents in patients with a ventricular assist device. J Thorac Cardiovasc Surg. 2007;134(1):114–23.CrossRefPubMed
62.
Kirklin JK, Naftel DC, Kormos RL, Pagani FD, Myers SL, Stevenson LW, et al. Interagency registry for mechanically assisted circulatory support (INTERMACS) analysis of pump thrombosis in the HeartMate II left ventricular assist device. J Heart Lung Transplant. 2014;33(1):12–22.CrossRefPubMed
63.
Zierer A, Melby SJ, Voeller RK, Guthrie TJ, Ewald GA, Shelton K, et al. Late-onset driveline infections: the Achilles’ heel of prolonged left ventricular assist device support. Ann Thorac Surg. 2007;84(2):515–20.CrossRefPubMed
64.
• Mehra MR, Naka Y, Uriel N, Goldstein DJ, Cleveland JC Jr, Colombo PC, et al. A fully magnetically levitated circulatory pump for advanced heart failure. N Engl J Med. 2017;376(5):440–50. Randomised trial of Heartmate 2 versus Heartmate 3. CrossRefPubMed
65.
66.
Stevenson LW, Pagani FD, Young JB, Jessup M, Miller L, Kormos RL, et al. INTERMACS profiles of advanced heart failure: the current picture. J Heart Lung Transplant. 2009;28(6):535–41.CrossRefPubMed
Metadata
Title
Mechanical Circulatory Support for Decompensated Heart Failure
Authors
Tarique Al Musa
Colin Dominic Chue
Hoong Sern Lim
Publication date
01-10-2017
Publisher
Springer US
Published in
Current Heart Failure Reports / Issue 5/2017
Print ISSN: 1546-9530
Electronic ISSN: 1546-9549
DOI
https://doi.org/10.1007/s11897-017-0349-5

Other articles of this Issue 5/2017

Current Heart Failure Reports 5/2017 Go to the issue

Epidemiology of Heart Failure (J Ho, Section Editor)

Epidemiology of Sleep-Disordered Breathing and Heart Failure: What Drives What

Pathophysiology of Myocardia Failure (I Anand and M Patarroyo-Aponte, Section Editors)

Prevention of Chemotherapy Induced Cardiomyopathy

Erratum

Erratum to: Updates in Cardiac Resynchronization Therapy for Chronic Heart Failure: Review of Multisite Pacing

Management of Heart Failure (T Meyer, Section Editor)

Diagnosis and Management of Heart Failure in Long-Term Dialysis Patients

Decompensated Heart Failure (P Banerjee, Section Editor)

Inpatient Monitoring of Decompensated Heart Failure: What Is Needed?

Management of Heart Failure (T Meyer, Section Editor)

Vitamin D and Heart Failure
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits