[Vetricular Assist Device Therapy for Acure Cardiogenic Shock]

The optimal treatment for severe heart failure is heart transplantation. However, owing to the lack of donor hearts, mechanical circulatory support is sometimes necessary to maintain life until a donor heart is available for transplantation. In Japan, an implantable ventricular assist devices (VADs) were accepted by the social healthcare insurance in 2011. The mid-term results of implantable VADs are reported to be excellent. However, the use of implantable VADs as a bridge to transplantation is limited in patients with a hemodynamic condition of Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 2 or better rating. Therefore, an extracorporeal VAD has been utilized for patients with acute deteriorated hemodynamic conditions who have not yet been registered in the heart transplantation network. Because the extracorporeal VAD has been associated with high incidences of postoperative life-threatening complications such as stroke, bleeding and infection, its role is now limited to bridge to candidacy or bridge to recovery. The device should be removed if heart function is adequately recovered or should be converted to an implantable VAD immediately after the patient's systemic condition has recovered and the patient is registered in the heart transplantation network.