Assist devices for circulatory support in therapy-refractory acute heart failure

Acute cardiogenic shock has a high mortality. The number of mechanical circulatory assist devices to encounter this life-threatening condition is steadily growing. These devices enable physicians to treat patients with acute cardiac failure refractory to conventional therapy. Mechanical circulatory assist devices are considered last resort to prevent or to reverse a cardiogenic shock. Different centrifugal, pulsatile or nonpulsatile (axial) flow pumps are available to rescue patients in different scenarios. These mechanical circulatory assist devices can be placed percutaneously or surgically as extracorporeal or intracorporeal mechanical circulatory assist devices.

Percutaneous mechanical circulatory assist devices are useful to establish rapid life-saving circulatory support under different circumstances. A stabilized patient can then be transferred to an intensive care unit, a catheterization laboratory or an operating room for further assessment and additional treatment with possible change to a mid-term or long-term mechanical circulatory assist device.

Percutaneous mechanical circulatory assist devices can be implanted in an emergency setting in patients with acute cardiogenic shock refractory to conventional therapy irrespective of the given location. The choice for a specific mechanical circulatory assist device should be based on the underlying condition and individualized prognosis. Based on the findings of this review, circulatory or axial-flow pumps should be considered first-line devices.