Short-term percutaneous mechanical circulatory support: no promise without positioning!

Area of Science:

• Cardiology
• Intensive Care Medicine
• Medical Device Technology

Background:

• Short-term mechanical circulatory support with micro-axial flow pumps is vital for left ventricular support in cardiogenic shock.
• Proper management of percutaneous ventricular assist devices (pVADs) in the cardiac intensive care unit is essential for optimal function and hemodynamic stability.
• Correct pVAD positioning is a critical factor for successful device therapy.

Approach:

• This review focuses on achieving and maintaining optimal left-sided pVAD positioning, emphasizing insertion depth and rotational angle.
• It discusses imaging techniques, placement/replacement maneuvers, and console monitoring for pVAD management.
• A bedside approach is proposed to assess pVAD position and differentiate suction alarms from hemodynamic issues.

Key Points:

• Optimal pVAD position is critical for effective hemodynamic support and preventing device-related complications.
• Mal-rotation towards the mitral valve can lead to suction alarms, hemolysis, aortic regurgitation, and inadequate support.
• Accurate assessment of pVAD position is necessary to distinguish device mal-positioning from primary hemodynamic problems.

Conclusions:

• Achieving and maintaining correct pVAD position is paramount for patients with cardiogenic shock requiring mechanical circulatory support.
• Understanding device mechanics and potential mal-positioning issues aids in optimizing patient outcomes.
• This review provides practical guidance for clinicians managing pVADs in the intensive care setting.