Mechanical circulatory support for management of cardiogenic shock beyond intraaortic balloon pump support and inotropes

Abstract

The use of ventricular assist devices (VADs) has become a widely accepted therapeutic option in end-stage cardiac failure. Most commonly, VADs are indicated as a bridge to transplantation in chronic heart disease. A variety of cardiovascular conditions such as myocardial infarction, dilatative cardiomyopathy, and myocarditis can lead to severe acute heart failure, which, in some cases, results in persistent cardiogenic shock. Irrespective of the etiology and despite new intervention measures, morbidity and mortality rates of cardiogenic shock patients remain unacceptably high. For patients who remain in cardiogenic shock despite optimal medical therapy and intraaortic balloon pumping (IABP), implantation of a VAD might be the last lifesaving therapeutic option. The longer end-organ malperfusion persists, the poorer the chance of survival. Ventricular assist device therapy can provide hemodynamic support, allowing cardiac function to recover while peripheral perfusion is maintained at adequate levels. © 2008 Springer-Verlag London.