[Update Cardiac Support and Assist Therapies]

Area of Science:

• Cardiology
• Medical Device Technology
• Critical Care Medicine

Background:

• Heart failure management increasingly relies on advanced medical devices.
• Mechanical circulatory support (MCS) offers critical interventions for acute and chronic conditions.

Purpose of the Study:

• To review current mechanical chest compression devices (mCPR), extracorporeal membrane oxygenation (ECMO), and surgically implanted ventricular assist devices (VADs).
• To discuss the application of these devices as bridge-to-recovery, bridge-to-transplant, or destination therapy.
• To highlight newer concepts like combined ECMO-Impella and Veno-Veno-Arterial ECMO.

Main Methods:

• Review of current literature and clinical applications of various MCS devices.
• Discussion of principles, limitations, and evolving concepts in ECMO and VADs.
• Analysis of device roles in different heart failure management strategies.

Main Results:

• Venovenous ECMO is widely accepted; Venoarterial ECMO is increasingly used for extracorporeal CPR (eCPR).
• Surgically implanted LVADs, RVADs, biventricular VADs, and TAH are standard for bridge-to-transplant or destination therapy.
• Emerging strategies include venovenoarterial ECMO and combined ECMO-Impella support.

Conclusions:

• Mechanical circulatory support devices provide essential life-saving interventions for heart failure.
• The choice of device depends on the patient's condition, serving as bridge-to-recovery or bridge-to-transplant.
• Quality of life and device-associated restrictions must be carefully weighed against the benefits of these life-sustaining technologies.