Vol 79, No 12 (2021)
Expert opinion
Published online: 2021-12-03

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Mechanical circulatory support. An expert opinion of the Association of Intensive Cardiac Care and the Association of Cardiovascular Interventions of the Polish Cardiac Society

Agnieszka Tycińska1, Marek Grygier2, Jan Biegus3, Tomasz Czarnik4, Maciej Dąbrowski5, Rafał Depukat6, Marek Gierlotka7, Monika Gil1, Michał Hawranek8, Tomasz Hirnle9, Marek Jemielity10, Bogusław Kapelak1112, Paweł Kralisz13, Wiktor Kuliczkowski3, Mariusz Kuśmierczyk14, Marcin Ligowski10, Paulina Łopatowska1, Mateusz Puślecki1015, Andrzej Świątkowski16, Przemysław Trzeciak8, Barbara Zawiślak17, Michał Zembala1819, Robert Zymliński3
Pubmed: 34861044
Kardiol Pol 2021;79(12):1399-1410.

Abstract

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.

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