Mechanical circulatory support for end-stage heart failure.
Mechanical circulatory assistance has become a frequent therapeutic option for patients with advanced heart failure. For patients with acute cardiogenic shock and impaired organ function, short-term assistance with venoarterial extracorporeal membrane oxygenation is the leading therapeutic option. It enables a "bridge to decision-making" i.e. withdrawal of the device after myocardial recovery or after recognition of therapeutic futility, or as a bridge-to-transplantation or to long-term mechanical support. For Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) class 2-6 patients, implantation of a long-term ventricular assist-device (VAD) should be considered before progression to multiple organ failure if heart transplantation is not a first-line option. Most patients receive a miniaturized axial or centrifugal fully implantable left VAD as a bridge-to-transplantation or as "destination therapy" in this setting.
Medical-Surgical Intensive Care Unit, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, F-75013 Paris, France; Sorbonne University, UPMC Univ Paris 06, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, F-75013 Paris, France. Electronic address: alain.combes@aphp.fr.
Alain
A
Combes
D000066491:Clinical Decision-Making; D018450:Disease Progression; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000639:trends; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000639:trends; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects / Q000639:trends; D006801:Humans; D009102:Multiple Organ Failure / Q000209:etiology / Q000517:prevention & control; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000209:etiology / Q000503:physiopathology / Q000601:surgery
Cardiogenic; Extracorporeal membrane oxygenation (ECMO); Left ventricular assist device (LVAD); Mechanical circulatory support; Shock