Percutaneous ventricular assistance
Summary
The era of interventional cardiovascular therapeutics has evolved dramatically since the initial percutaneous interventions (PCI) of the 1970s. Sicker patients presenting to the catheterisation laboratory with complex and high-risk lesions are now common practice. Despite technological advances leading to improved outcomes after myocardial infarction, the mortality of patients presenting with cardiogenic shock remains unacceptably high.
This combination of factors has led to the development of percutaneous ventricular assist devices (PVADs) opening a new dimension of possibilities for these patients.
This chapter outlines the principles of percutaneous circulatory assistance, describes the different devices ranging from intra-aortic balloon pump, PVADs with different configurations, to percutaneous cardiopulmonary support with extracorporeal membrane oxygenation (ECMO); and reviews the current literature surrounding their use.
These PVADs have demonstrated improved metabolic profile, efficient cardiac unloading and circulatory support. However, despite more than a decade of mainstream use, it has been challenging to demonstrate clear survival advantage to date. For these reasons, in addition to the challenges with randomized control trials in these patients, a catheter-based VAD registry was created. These efforts will hopefully lead to better understanding on when to use this technology as the devices become better and smaller.
Introduction
The dramatic transformation of interventional...
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