Chapter 9 - Mechanical circulatory support

Summary

This chapter focuses on two of the options: the intra-aortic balloon pump (IABP) and ventricular assist devices (VADs). The decision of whether to proceed to mechanical circulatory support (MCS) depends on the aetiology of the heart failure and on the likely long-term treatment strategy. Which method of MCS is deployed depends on the acuteness of onset of heart failure, its potential reversibility, its severity and the anticipated duration of support required. VADs can be used to augment perfusion and relieve congestion, potentially reversing the damaging effects of severe heart failure. A left ventricular assist device (LVAD) withdraws oxygenated blood from the left atrium or left ventricle, and returns it to the aorta; a right ventricular assist device (RVAD) draws venous blood from the right atrium, and returns it to the pulmonary artery. The VAD implant procedure should be covered by broad-spectrum prophylactic antibiotics and antifungal agents.