Open AccessMechanical circulatory support. An expert opinion of the Association of Intensive Cardiac Care and the Association of Cardiovascular Interventions of the Polish Cardiac Society
Author(s) -
Agnieszka Tycińska,
Marek Grygier,
Jan Biegus,
Tomasz Czarnik,
Maciej Dąbrowski,
Rafał Depukat,
Marek Gierlotka,
Monika Gil,
Michał Hawranek,
Tomasz Hirnle,
Marek Jemielity,
Bogusław Kapelak,
Paweł Kralisz,
Wiktor Kuliczkowski,
Mariusz Kuśmierczyk,
Marcin Ligowski,
Paulina Łopatowska,
Mateusz Puślecki,
Andrzej Marian Świątkowski,
Przemysław Trzeciak,
Barbara Zawiślak,
Michał Zembala,
Robert Zymliński
Publication year - 2021
Publication title -
kardiologia polska
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.527
H-Index - 34
eISSN - 1897-4279
pISSN - 0022-9032
DOI - 10.33963/kp.a2021.0169
Subject(s) - medicine , impella , cardiogenic shock , extracorporeal membrane oxygenation , percutaneous , heart failure , intensive care medicine , conventional pci , cardiology , percutaneous coronary intervention , psychological intervention , myocardial infarction , psychiatry
Mechanical circulatory support (MCS) methods are used in patients with both acute and chronic heart failure, who have exhausted other options for pharmacological or surgical treatments. The purpose of their use is to support, partially or completely, the failed ventricles and ensure adequate organ perfusion, which allows patients to restore full cardiovascular capacity, prolonging their life and effectively improving its quality. The three most popular devices include an intra-aortic balloon pump (IABP), percutaneous assist devices (including Impella, TandemHeart), and venoarterial extracorporeal membrane oxygenation (VA-ECMO). A multidisciplinary approach with the special participation of the Heart Team is required to determine the proper MCS strategy, the choice of the supporting method, and the time of its use. The studies published so far do not allow us to determine which MCS method is the safest and the most effective. Thus, the site experience and accessibility of the method seem to matter most today. MCS finds particular application in patients with acute coronary syndromes complicated by refractory cardiogenic shock, as well as in patients with acute heart failure of the high potential for reversibility. It can also serve as a backup for percutaneous coronary interventions of high risk (complex and high-risk indicated percutaneous coronary intervention [PCI], complex and high-risk indicated PCI [CHIP]). The use of appropriate supportive drugs, precise hemodynamic and echocardiographic monitoring, as well as optimal non-invasive or mechanical ventilation, are extremely important in the management of a patient with MCS. The most serious complications of MCS include bleeding, thromboembolic events, as well as infections, and hemolysis.