Mechanical Circulatory Support

  • Daniel H. Katz
  • Marwa A. SabeEmail author
Part of the Contemporary Cardiology book series (CONCARD)


In other chapters, there are detailed discussions of acute decompensated heart failure (Chap.  19) and shock (Chap.  21). Cardiogenic shock (CS) represents a state in which cardiac dysfunction is either wholly or partially responsible for an inadequate level of cardiac output to support end-organ function. CS is an especially dangerous state, with in-hospital mortality as high as 27–51% (van Diepen et al., Circulation. 136:e232–68, 2017). Therefore, interventions that promptly reverse the pathophysiologic process are critical. While CS can result from a variety of etiologies – acute myocardial infarction (AMI), acute valvular regurgitation, decompensated heart failure, ventricular tachycardic storm, or myocarditis, to name just a few – once the insult triggers primary dysfunction, the nature of CS is a downward spiral of consequences ultimately resulting in multi-organ failure and death. Even if myocardial ischemia is not the primary cause of cardiac dysfunction, a drop in cardiac output and coronary perfusion pressure during CS nonetheless leads to ischemia and further systolic and diastolic dysfunction, both of which precipitate a feedback loop of progressive dysfunction. This chapter focuses on the use of mechanical circulatory support (MCS) to intervene in the early stages of this cycle.


  1. 1.
    van Diepen S, Katz JN, Albert NM, et al. Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association. Circulation. 2017;136(16):e232–68. Scholar
  2. 2.
    Uriel N, Sayer G, Annamalai S, Kapur NK, Burkhoff D. Mechanical unloading in heart failure. J Am Coll Cardiol. 2018;72(5):569–80. Scholar
  3. 3.
    Thiele H, Ohman EM, Desch S, Eitel I, de Waha S. Management of cardiogenic shock. Eur Heart J. 2015;36(20):1223–30. Scholar
  4. 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. Scholar
  5. 5.
    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.
  6. 6.
    Naqvi SY, Salama IG, Yoruk A, Chen L. Ambulatory intra aortic balloon pump in advanced heart failure. Card Fail Rev. 2018;4(1):43–5. Scholar
  7. 7.
    Kern MJ, Aguirre FV, Tatineni S, et al. Enhanced coronary blood flow velocity during intraaortic balloon counterpulsation in critically ill patients. J Am Coll Cardiol. 1993;21(2):359–68.CrossRefGoogle Scholar
  8. 8.
    Briceno N, Kapur NK, Perera D. Percutaneous mechanical circulatory support: current concepts and future directions. Heart. 2016;102(18):1494–507. Scholar
  9. 9.
    Thiele H, Zeymer U, Neumann F-J, et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med. 2012;367(14):1287–96. Scholar
  10. 10.
    Badiye AP, Hernandez GA, Novoa I, Chaparro SV. Incidence of hemolysis in patients with cardiogenic shock treated with Impella percutaneous left ventricular assist device. ASAIO J. 2016;62(1):11–4. Scholar
  11. 11.
    Flierl U, Tongers J, Berliner D, et al. Acquired von Willebrand syndrome in cardiogenic shock patients on mechanical circulatory microaxial pump support. PLoS One. 2017;12(8):e0183193. Scholar
  12. 12.
    Castillo-Sang MA, Prasad SM, Singh J, Ewald GA, Silvestry SC. Thirty-five day Impella 5.0 support via right axillary side graft cannulation for acute cardiogenic shock. Innovations (Phila). 2013;8(4):307–9. Scholar
  13. 13.
    Seyfarth M, Sibbing D, Bauer I, 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. Scholar
  14. 14.
    Engström AE, Cocchieri R, Driessen AH, et al. The Impella 2.5 and 5.0 devices for ST-elevation myocardial infarction patients presenting with severe and profound cardiogenic shock: the Academic Medical Center intensive care unit experience. Crit Care Med. 2011;39(9):2072–9. Scholar
  15. 15.
    Ouweneel DM, Eriksen E, Sjauw KD, 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. Scholar
  16. 16.
    O’Neill WW, Schreiber T, Wohns DHW, et al. The current use of Impella 2.5 in acute myocardial infarction complicated by cardiogenic shock: results from the USpella registry. J Interv Cardiol. 2014;27(1):1–11. Scholar
  17. 17.
    Hall SA, Uriel N, Carey SA, et al. Use of a percutaneous temporary circulatory support device as a bridge to decision during acute decompensation of advanced heart failure. J Heart Lung Transplant. 2018;37(1):100–6. Scholar
  18. 18.
    Lima B, Kale P, Gonzalez-Stawinski GV, Kuiper JJ, Carey S, Hall SA. Effectiveness and safety of the Impella 5.0 as a bridge to cardiac transplantation or durable left ventricular assist device. Am J Cardiol. 2016;117(10):1622–8. Scholar
  19. 19.
    Gilotra NA, Stevens GR. Temporary mechanical circulatory support: a review of the options, indications, and outcomes. Clin Med Insights Cardiol. 2015;8(Suppl 1):75–85. Scholar
  20. 20.
    Burkhoff D, Cohen H, Brunckhorst C, O’Neill WW. A randomized multicenter clinical study to evaluate the safety and efficacy of the TandemHeart percutaneous ventricular assist device versus conventional therapy with intraaortic balloon pumping for treatment of cardiogenic shock. Am Heart J. 2006;152(3):469.e1–8. Scholar
  21. 21.
    Thiele H, Sick P, Boudriot E, et al. Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J. 2005;26(13):1276–83. Scholar
  22. 22.
    Gregoric ID, Cohn WE, Akay MH, La Francesca S, Myers T, Frazier OH. CentriMag left ventricular assist system. Tex Heart Inst J. 2008;35(2):184–5.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Rao P, Khalpey Z, Smith R, Burkhoff D, Kociol RD. Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest. Circ Heart Fail. 2018;11(9):e004905. Scholar
  24. 24.
    Patel S, Lipinski J, Al-Kindi S, et al. Simultaneous venoarterial extracorporeal membrane oxygenation and percutaneous left ventricular decompression therapy with Impella is associated with improved outcomes in refractory cardiogenic shock. ASAIO J. 2019;65(1):21–8. Scholar
  25. 25.
    Kapur NK, Esposito M. Hemodynamic support with percutaneous devices in patients with heart failure. Heart Fail Clin. 2015;11(2):215–30. Scholar
  26. 26.
    Hoeper MM, Tudorache I, Kühn C, et al. Extracorporeal membrane oxygenation watershed. Circulation. 2014;130(10):864–5. Scholar
  27. 27.
    Cakici M, Gumus F, Ozcinar E, et al. Controlled flow diversion in hybrid venoarterial-venous extracorporeal membrane oxygenation. Interact Cardiovasc Thorac Surg. 2018;26(1):112–8. Scholar
  28. 28.
    Madershahian N, Nagib R, Wippermann J, Strauch J, Wahlers T. A simple technique of distal limb perfusion during prolonged femoro-femoral cannulation. J Card Surg. 2006;21(2):168–9. Scholar
  29. 29.
    Millar JE, Fanning JP, McDonald CI, McAuley DF, Fraser JF. The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology. Crit Care. 2016;20(1):387. Scholar
  30. 30.
    Lim HS, Howell N, Ranasinghe A. The physiology of continuous-flow left ventricular assist devices. J Card Fail. 2017;23(2):169–80. Scholar
  31. 31.
    Feldman D, Pamboukian SV, Teuteberg JJ, et al. The 2013 International Society for Heart and Lung Transplantation guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant. 2013;32(2):157–87. Scholar
  32. 32.
    Kapur Navin K, Esposito Michele L, Yousef B, et al. Mechanical circulatory support devices for acute right ventricular failure. Circulation. 2017;136(3):314–26. Scholar
  33. 33.
    Kuchibhotla S, Esposito ML, Breton C, et al. Acute biventricular mechanical circulatory support for cardiogenic shock. J Am Heart Assoc. 2017;6(10).

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Beth Israel Deaconess Medical CenterBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA

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