2
Key Points
Î Mechanical circulatory support (MCS) has evolved from a rarely used
therapy reserved for the most critically ill hospitalized patients to
an accepted long-term outpatient therapy for treating patients with
advanced heart failure.
Î Cardiac arrest in patients on mechanical support is a new
phenomenon brought about by the increased use of this therapy in
patients with end-stage heart failure.
Î Because of the unique characteristics of mechanical support, these
patients have physical findings that cannot be interpreted the same as
for patients without MCS.
• For example, stable patients supported by a durable, continuous-flow ventricular
assist device (VAD) often do not have a palpable pulse.
Î Long-term MCS devices suitable for nonhospitalized patients are
placed largely for 1 of 2 indications. These 2 designations are fluid.
Patients can have their status changed from bridge to transplantation
to destination therapy or vice versa on the basis of clinical changes.
1. Bridge to transplantation refers to patients awaiting heart transplantation whose
heart failure progresses despite medical therapy. In such cases, MCS is used as a
bridge until a donor organ becomes available.
2. Destination therapy refers to patients with advanced systolic heart failure who
are not candidates for transplantation because of factors such as comorbidities or
advanced age.
Note: In this population, MCS is the destination itself, as opposed to transplantation,
and patients will typically live the remainder of their lives on mechanical support.
This population is growing rapidly, with some patients being supported for many
years.
Î MCS can support function of the left ventricle (LV) with a left VAD
(LVAD), the right ventricle (RV) with a right VAD (RVAD), or both
ventricles with a biventricular assist device. A total artificial heart
(TAH) replaces the heart itself.
