Temporary Left Ventricular Assist Devices: Indications and Patient Selection

Temporary percutaneous left ventricular assist devices (pLVADs), most prominently transvalvular microaxial flow pumps, have become central tools for contemporary cardiogenic shock care and for hemodynamic protection during selected high-risk percutaneous coronary interventions. Their value, however, is determined far more by patient selection and timing than by device capability alone. This article frames pLVAD use as a high-stakes triage decision anchored in shock phenotype, trajectory, reversibility, and an explicit exit strategy (bridge-to-recovery, bridge-to-decision, bridge-to-transplant, or bridge-to-durable left ventricular assist device).