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  • Review article
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Temporary mechanical circulatory support devices: practical considerations for all stakeholders

Nature Reviews Cardiology volume 20, pages 263–277 (2023)Cite this article

Subjects

Abstract

Originally intended for life-saving salvage therapy, the use of temporary mechanical circulatory support (MCS) devices has become increasingly widespread in a variety of clinical settings in the contemporary era. Their use as a short-term, prophylactic support vehicle has expanded to include procedures in the catheterization laboratory, electrophysiology suite, operating room and intensive care unit. Accordingly, MCS device design and technology continue to develop at a rapid pace. In this Review, we describe the functionality, indications, management and complications associated with temporary MCS, together with scenario-specific utilization, goal-directed development and bioengineering of future devices. We address various considerations for the use of temporary MCS devices in both prophylactic and rescue scenarios, with input from stakeholders from various cardiovascular specialties, including interventional and heart failure cardiology, electrophysiology, cardiothoracic anaesthesiology, critical care and cardiac surgery.

Key points

  • The use of mechanical circulatory support (MCS) devices involves several different stakeholders and requires a multidisciplinary approach to consideration and management.

  • Choosing the appropriate MCS device involves a thorough evaluation of the patient’s phenotype, history, physical condition, laboratory data, haemodynamic deficit (univentricular or biventricular compromise) and echocardiographic findings and the objectives of care.

  • Optimal patient outcome is continually reassessed and is based on a balanced intersection between the objectives and level of support, the risk of complications, timing and the available resources.

  • Important opportunities for MCS innovation include challenges related to pump size, vascular access, biocompatibility and use in the ambulatory setting.

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Fig. 1: Left ventricular circulatory support devices.
Fig. 2: Right ventricular circulatory support devices.
Fig. 3: Effects of MCS devices on pressure–volume loops and blood pressure.

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Authors and Affiliations

  1. Department of Anaesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Benjamin S. Salter, Caroline R. Gross & Menachem M. Weiner

  2. Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Srinivas R. Dukkipati

  3. Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai, New York, NY, USA

    Gregory W. Serrao, Noah Moss & Anuradha Lala

  4. Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Anelechi C. Anyanwu

  5. Cardiovascular Research Foundation, New York, NY, USA

    Daniel Burkhoff

  6. Department of Population Health Science and Policy, Mount Sinai, New York, NY, USA

    Anuradha Lala

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B.S.S., C.R.G., S.R.D., G.W.S., N.M., A.C.A., D.B. and A.L. researched data for the article. B.S.S., C.R.G., A.C.A., D.B. and A.L. discussed the content. All the authors wrote the manuscript. B.S.S, C.R.G., M.M.W., A.C.A., D.B. and A.L. reviewed and/or edited the article before submission.

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Correspondence to Benjamin S. Salter.

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Competing interests

S.R.D. declares receiving research grant support from Biosense Webster and owning equity in Farapulse (acquired by Boston Scientific) and Manual Surgical Sciences. D.B. declares receiving an unrestricted educational grant from Abiomed, acting as a consultant to PVLoops and receiving consulting fees from CardioDyme. A.L. declares receiving speaker honoraria from Zoll, being on a data safety and monitoring board for Sequana, being on the advisory board of Bioventrix and being a speaker for Novartis. The other authors declare no competing interests.

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Salter, B.S., Gross, C.R., Weiner, M.M. et al. Temporary mechanical circulatory support devices: practical considerations for all stakeholders. Nat Rev Cardiol 20, 263–277 (2023). https://doi.org/10.1038/s41569-022-00796-5

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