Percutaneous mechanical circulatory support systems, particularly the Impella and TandemHeart devices, provide superior hemodynamic support compared with pharmacologic therapy. These devices should remain available clinically and be appropriately reimbursed.
Patients in cardiogenic shock represent an extremely high-risk group in whom mortality has remained high despite revascularization and pharmacologic therapies. Early placement of an appropriate mechanical circulatory support system may be considered in those who fail to stabilize or show signs of improvement quickly after initial interventions.
Mechanical circulatory support may be considered for patients undergoing high-risk PCI. Examples include patients requiring multivessel, left main or last patent conduit interventions, particularly if they are inoperable or have severely decreased ejection fraction or elevated cardiac-filling pressures.
In the setting of profound cardiogenic shock, an intra-aortic balloon pump is less likely to provide benefit than continuous flow pumps including the Impella CP and TandemHeart. ECMO may also provide benefit, particularly for patients with impaired respiratory gas exchange.
Patients with acute decompensated HF may benefit from early use of percutaneous mechanical circulatory support systems when they continue to deteriorate despite initial interventions.
There are insufficient data to confirm whether routine use of mechanical circulatory support systems as an adjunct to primary revascularization in the setting of large acute MI is useful in reducing reperfusion injury or infarct size.
Registries and randomized controlled trials comparing different strategies in different clinical scenarios are critically needed.
Early analyses suggest percutaneous mechanical circulatory support systems are cost-effective, but more data are needed. — by Erik Swain
Source: Rihal CS, et al. J Am Coll Cardiol. 2015;doi:10.1016/j.jacc.2015.02.043.