Mechanical support of the heart

Barbora Parizkova, I. Gavin Wright, Emma J. Birks

Research output: Contribution to journalReview articlepeer-review

Abstract

Mechanical support of the heart can be offered to patients who are refractory to pharmacological treatment, therapy for coronary or valvular disease or resynchronization therapy. Ventricular assist devices enable end-organ perfusion in the setting of heart failure. This can be temporary (as a bridge to recovery or transplantation) or permanent (destination therapy). Devices can be extracorporeal or implanted, and generated flows can be pulsatile or non-pulsatile. Implantation usually requires sternotomy with or without cardiopulmonary bypass, but percutaneous devices exist. Cardiostable anaesthesia with inotropic support is vital. Problems include bleeding versus thrombosis, high pulmonary vascular resistance, right heart failure and late infections. Transoesophageal echocardiography can be used to detect potential right-to-left atrial shunts, aortic regurgitation and cannula malposition, and to monitor filling and right ventricular function after implantation. In the future, total implantability of the devices, including the power source, is likely to occur. Eventually, they are likely to become a widespread alternative to transplantation.

Original languageEnglish
Pages (from-to)504-507
Number of pages4
JournalAnaesthesia and Intensive Care Medicine
Volume16
Issue number10
DOIs
StatePublished - Oct 2015

Bibliographical note

Publisher Copyright:
© 2015 Published by Elsevier Ltd.

Keywords

  • Bridge to transplantation
  • destination therapy
  • heart failure
  • mechanical support
  • ventricular assist devices

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Anesthesiology and Pain Medicine

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