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Published on: June 12, 2021
Optimal Large-Bore Vascular Access and Closure for Percutaneous Mechanical Circulatory Support in Cardiogenic Shock
Alexander G Truesdell1, Raghav Gattani1, Yasser Jamil2
1Virginia Heart, Falls Church, VA, USA; Inova Schar Heart and Vascular, Falls Church, VA, USA.
Insights
Large-bore arterial and venous access for mechanical circulatory support devices can cause bleeding and vascular injuries. Optimizing device management and closure protocols is crucial for patient safety and outcomes in cardiogenic shock.
Area of Science:
- Cardiovascular Medicine
- Medical Device Technology
Background:
- Percutaneous mechanical circulatory support (MCS) devices are vital for managing cardiogenic shock.
- Large-bore vascular access is necessary for MCS device implantation, but carries risks.
Purpose of the Study:
- To highlight the importance of optimizing vascular access and device management protocols for MCS devices.
- To discuss current and future innovations aimed at improving safety and efficacy.
Main Methods:
- Literature review and synthesis of current best practices in vascular access and device management.
- Analysis of ongoing innovations in device design and procedural protocols.
Main Results:
- Bleeding and vascular injuries are significant adverse events associated with large-bore arterial and venous access.
- Optimal management of vascular access, indwelling devices, and closure techniques are critical.
Conclusions:
- Adherence to established protocols and embracing innovations are key to enhancing the safety and efficacy of MCS devices.
- Future advancements in device design and management strategies are expected to improve outcomes for cardiogenic shock patients.
Abstract:
Bleeding and vascular injuries are common and serious adverse consequences of large-bore arterial and venous access. Optimal vascular access, indwelling device management, device removal, and arteriotomy and venotomy closure protocols are essential for safe and effective use of percutaneous mechanical circulatory support devices for cardiogenic shock. Ongoing innovations in best-practices, vascular safety bundles, and sheath and device design, hemocompatibility, performance, and miniaturization are expected to further improve device safety and efficacy-and cardiogenic shock patient outcomes-in the future.
