Journal of Invasive Cardiology

Abstract: Percutaneous ventricular assist devices are increasingly used today, allowing the scope of left ventricular support to move out of the operating room and into the interventional suite and cardiovascular care unit. This has given patients requiring short-term therapy an opportunity to undergo high-risk procedures and provide a failing left ventricular support until native recovery can occur. A growing body of evidence exists that demonstrates device efficacy and safety, as well as its potential clinical importance, a topic that will be reviewed here. Additionally, many providers seek a resource for technical considerations and troubleshooting. We also aim to provide insight into such considerations. 

J INVASIVE CARDIOL 2012;24(1):25-31

Key words: percutaneous left ventricular support, percutaneous left ventricular assist device, cardiogenic shock, high-risk percutaneous coronary intervention

_______________________________________

Historical Perspective

The concept of mechanical circulatory support has matured over several decades, with the first long-term surgical application in humans in 1966.¹ The original design of surgical ventricular assist devices (VADs) attempted to mimic cardiopulmonary bypass, and allowed patient’s passage to hospital units where continued myocardial recovery could be supported at the bedside via large, yet moveable consoles. The subsequent growing need for long-term support in the era of cardiac transplantation, where many patients died awaiting heart donation, fueled the development of more sophisticated intracorporeal devices that not only allowed movement out of the operating room, but also movement out of the hospital. Yet many patients require effective circulatory support for short or intermediate duration where surgical VADs are not warranted, making temporary percutaneous options feasible and necessary. Until recently, the only option available for such indications was the intra-aortic balloon pump (IABP).