Hemodynamic Support: Science and Evaluation of the Assisted Circulation with Percutaneous Assist Devices

Pathophysiologic mechanisms that lead to hemodynamic abnormalities in cardiogenic shock (including hypotension, hypoperfusion, and elevated venous pressures) are reviewed within the framework of pressure-volume analysis. This approach provides the foundation for understanding how different modes of circulatory support impact key these cardiovascular parameters in various clinical settings. Four fundamentally different modes of circulatory support are reviewed, including aortic counterpulsation, left atrial-to-arterial pumping, right atrial-to-arterial pumping, and left ventricular-to-aortic pumping. Each approach has a distinct hemodynamic fingerprint with regard to effects on the ventricular pressure-volume loop and key hemodynamic and metabolic parameters.