A new expert consensus statement provides new guidance for physicians in matching new percutaneous mechanical circulatory system (MCS) devices to patients for the treatment of heart failure. The statement was released April 7 by the ACC, the Society for Cardiovascular Angiography and Interventions, the Heart Failure Society of America, and The Society of Thoracic Surgeons, and was simultaneously published in the Journal of the American College of Cardiology.

In recent years, a number of new devices have entered clinical practice, each differing significantly in their insertion, monitoring and circulatory effects. Through a process of reviewing scientific data on all available devices – including intraaortic balloon pumps, left atrial to aorta assist devices, left ventricle to aorta assist devices, and extracorporeal membrane oxygenation – experts generated recommendations on the types of devices best suited to different heart failure patients. The full document “reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations,” according to the statement. This includes a review of the indications for percutaneous MCS, including complications of myocardial infarction, high-risk percutaneous coronary intervention, and advanced heart failure and cardiogenic shock.

According to the statement, percutaneous MCS provides superior hemodynamic support compared to medical therapy. MCS can also be beneficial to high-risk percutaneous coronary intervention patients and certain patients with acute decompensated heart failure with worsening symptoms. Patients in cardiogenic shock may also benefit from early MCS placement when initial interventions do not stabilize the patient. Finally, MCS can also be utilized in patients who failed to wean off cardio-pulmonary bypass. The statement reports that, “there are insufficient data to support or refute the notion that routine use of MCSs as an adjunct to primary revascularization in the setting of large acute myocardial infarction is useful in reducing reperfusion injury or infarct size.” 

“Percutaneous MCS is revolutionizing the treatment of high-risk cardiac patients,” said Charanjit S. Rihal, MD, FACC, chair of the Division of Cardiovascular Diseases at the Mayo Clinic and lead author of the paper. “In certain patients, these devices can mean the difference between recovery and the need for heart transplant or death, and they may be used to maintain hemodynamic stability during interventional procedures and as a bridge to longer-term treatment. The new consensus statement will help physicians select devices for the patients who are most likely to benefit.”

“MCS utilization is clearly increasing, and this document should assist clinicians in recognizing when early support is needed, and what that support should look like,” adds Srihari S. Naidu, MD, FACC, director of the Cardiac Cath. Lab at Winthrop University Hospital and vice-chair of the consensus document’s writing committee.

The statement emphasizes that there is a critical need for registries and randomized controlled trials comparing different strategies across patient populations, as well as a need for further data on the cost-effectiveness of MCS for emergent use versus surgical extracorporeal membrane oxygenation or ventricular assist device support.  

Keywords: Angiography, Aorta, Consensus, Extracorporeal Membrane Oxygenation, Heart Failure, Heart Ventricles, Heart-Assist Devices, Hemodynamics, Myocardial Infarction, Percutaneous Coronary Intervention, Registries, Reperfusion Injury, Shock, Cardiogenic, Surgeons

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