Perioperative mechanical circulatory support

With increases in patient acuity, the use of devices that provide Mechanical Circulatory Support (MCS) is increasing rapidly. By extension, anesthesiologists are increasingly called upon to manage patients supported by MCS. The type of MCS can be categorized into left ventricular support, right ventricular support, biventricular support, and whether or not respiratory support (oxygenation and ventilation) is provided. Examples of MCS types include intra-aortic balloon pump (IABP), venoarterial extracorporeal membrane oxygenation (VA ECMO), venovenous ECMO, and transvalvular microaxial flow pumps. Clinical scenarios include patients already supported by MCS devices that require a procedure (such as exploratory laparotomy), patients requiring planned periprocedural support (such as VA ECMO for ventricular tachycardia ablation), and patients that acutely decompensate and require emergent rescue (such as cardiac arrest requiring VA ECMO). This review presents the available literature on select MCS types, anesthetic considerations by MCS type, and future research directions.