This Article Free upon publication Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Delgado, D. H. Articles by Smedira, N. G. Search for Related Content PubMed PubMed Citation Articles by Delgado, D. H. Articles by Smedira, N. G. Related Collections Congestive CV surgery: transplantation, ventricular assistance, cardiomyopathy

(Circulation. 2002;106:2046.)
© 2002 American Heart Association, Inc.

Clinician Update

Mechanical Circulatory Assistance

State of Art

Diego H. Delgado, MD; Vivek Rao, MD, PhD, FRCS (C); Heather J. Ross, MD, FRCP (C); Subodh Verma, MD, PhD; Nicholas G. Smedira, MD

From the Divisions of Cardiology (D.H.D., H.J.R.) and Cardiovascular Surgery (V.R., S.V.), Toronto General Hospital, Toronto, Canada; and Kaufman Heart Failure Center (N.G.S.), Cleveland Clinic Foundation, Cleveland, Ohio.

Correspondence to Vivek Rao, MD, PhD, FRCS (C), 14 EN 222, Toronto General Hospital, 200 Elizabeth St, Toronto, Ontario, Canada, M5G 2C4. E-mail Vivek.Rao@uhn.on.ca

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Case presentation 1: Patient 1 is a 24-year-old woman with a 3-day history of a flu-like syndrome who presented with cardiogenic shock. The patient has persistent cardiogenic shock without end-organ dysfunction despite appropriate hemodynamic support. Which type of mechanical assist device is indicated in this case?

Case presentation 2: Patient is a 47-year-old man with a 12-year history of chronic heart failure due to idiopathic dilated cardiomyopathy. He now presents with New York Heart Association class IV symptoms that are refractory to medical therapy. At what point should we consider this patient for mechanical circulatory support?

Mechanical circulatory support (MCS) is an important adjunct to the management of the patient with severe heart failure. This article describes the current clinically available mechanical support devices, their indications for use, and the specific advantages and disadvantages associated with each device.

	Indications for Support

 
MCS is life saving in patients who fail to improve or stabilize with intravenous inotropes or vasodilators, intra-aortic balloon pump support, and mechanical ventilation.¹ Patients requiring mechanical support generally fall into 4 categories: those with (1) cardiogenic shock resulting from acute myocardial infarction (AMI); (2) postsurgical myocardial dysfunction; (3) acute cardiac failure from myocarditis (case presentation 1); and (4) decompensated chronic heart failure (case presentation 2).

Patients who present in cardiogenic shock after an AMI are excellent candidates for either short- or long-term mechanical support because they have not developed the systemic organ dysfunction seen with chronic end-stage heart failure and have the potential for myocardial recovery. In our experience, . . . [Full Text of this Article]

This article has been cited by other articles:

				H. Thiele, R. W. Smalling, and G. C. Schuler Percutaneous left ventricular assist devices in acute myocardial infarction complicated by cardiogenic shock Eur. Heart J., September 1, 2007; 28(17): 2057 - 2063. [Abstract] [Full Text] [PDF]

				M. S. Nieminen Key issues of European Society of Cardiology guidelines on acute heart failure Eur. Heart J. Suppl., September 1, 2006; 8(suppl_E): E6 - E11. [Abstract] [Full Text] [PDF]

				Endorsed by the European Society of Intensive Care, Authors/Task Force Members, M. S. Nieminen, M. Bohm, M. R. Cowie, H. Drexler, G. S. Filippatos, G. Jondeau, Y. Hasin, J. Lopez-Sendon, et al. Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: The Task Force on Acute Heart Failure of the European Society of Cardiology Eur. Heart J., February 2, 2005; 26(4): 384 - 416. [Full Text] [PDF]