Mechanical Circulatory Support for Advanced Heart Failure

Abstract

Patients with end-stage heart failure or cardiogenic shock experience unacceptably high mortality despite advances in treatment made over the past 50 years. The effects of vasoactive drugs used to manage cardiogenic shock may be limited, being highly dependent on “remaining” heart function. Mechanical circulatory support improves cardiac output independent of heart function. Intra-aortic balloon pumps (IABPs) and extracorporeal membrane oxygenation (ECMO) are the devices most commonly used in Korea. Despite frequent use, the utility of IABPs in acute myocardial patients remains controversial, whereas ECMO affords sufficient systemic perfusion pressure to reverse end-organ dysfunction. Both can only be used as acute treatments, thus as a bridge-to-recovery or a bridge-to-transplantation. Percutaneous left ventricular assist devices (LVADs) such as TandemHeart® and Impella are not in use in Korea. Implanted LVADs improve long-term outcomes and may also serve as destination therapies. In the present manuscript, we briefly review percutaneous and implantable devices currently used in Korea for the management of advanced heart failure. (Korean J Med 2015;88:142-149)