Treatment options for end-stage cardiac failure

Abstract

Advanced heart failure (HF) and cardiogenic shock are heterogeneous entities. The Interagency Registry for Mechanical Assisted Circulatory Support (INTERMACS) has developed profile levels to better characterize clinical status. Beyond intra-aortic balloon pump (IABP) counterpulsation therapy and venoarterial extracorporeal membrane oxygenation (ECMO), various options have emerged for cardiac assist devices. Advanced HF support alternatives include percutaneous assist devices, short-term devices, and long-term, implantable ventricular assist devices (VADs). This chapter discusses the principles of application for these devices. The gold standard, however, for end-stage heart disease remains cardiac transplantation. With an ever-growing deficit in available donors compared to required organs, assist-device-based bridging strategies and strategic use of these grafts are paramount. Additionally, an approach to mechanical circulatory support (MCS) implantation stratified by INTERMACS profile levels (1-7), based on clinical goals and the required duration of assistance, is suggested.