Mechanical circulatory support devices: historical overview and modern approach.

Abstract

Heart failure (HF) continues to be a pervasive problem both nationally and globally, and with an aging population its prevalence is only increasing. It is estimated that ~6 million Americans over 20 years old were diagnosed with HF between 2015 and 2018, and projections estimate that the number will be > 8 million by 2030. There have been multiple classification systems developed to help risk stratify, prognosticate, and determine treatment forHF patients. These include theNewYork Heart Association (NYHA) functional classification, the American College of Cardiology (ACC) and American Heart Association (AHA) stages, and The Interagency Registry for Mechanically Assisted Circulation (INTERMACS) profiles. The ultimate goal of these systems is to provide early identification and create a pathway for intervention whether in the form of medical therapy, mechanical circulatory support (MCS), or a combination of both. The termMCS encompasses a wide variety of options ranging from percutaneous temporary devices used as a bridge-to-transplantation (BTT) or myocardial recovery to permanent implantable devices meant as destination therapy (DT). The MCS devices commonly used today include the intraaortic balloon pump (IABP), Impella (Abiomed, Danvers, MA), TandemHeart (LivaNova, London, UK), total artificial heart (TAH), venoarterial and veno-venous extracorporeal membrane oxygenation (VA-ECMO and VV-ECMO), durable left ventricular assist devices (LVAD), and percutaneous right ventricular assist devices (RVAD). Various models and configurations of these listed devices can be used to support the left or right ventricle individually (LV, RV), and some can be used to provide biventricular support. The who, what, andwhen ofMCS requires a multidisciplinary team approach, considering numerous variables in order to provide the optimal therapy for each individual patient. This article presents an overview of the history and indications for MCS, as well as how to select patients for MCS and a brief explanation of available devices.