Mechanical circulatory support: evolving perspectives

Mechanical circulatory support of the failing circulation is an emerging discipline. Prototype circulatory support services have been established in a few institutions but are spreading15. Intra-aortic balloon pumping, developmental only a decade ago, is now widespread. Pneumatically-actuated intra and extracorporeal left ventricular assist devices, federally-approved for clinical trials only 2 yrs ago, show encouraging early results. Efforts in West Germany, Austria, Switzerland, Russia and Japan are underway and a spirit of cooperation exists. There is a need to clarify and quantitate indications and timing for deployment, prior to the onset of multiple organ failure. Electrically and nuclear-activated LVAD's16--18 are being developed. Clarification of projected patient populations are needed and the role of the right heart in left ventricular assist device function requires further investigation. There is a need to define a reasonable clinical role for the much discussed and rather elusive total artificial heart. Many problems remain with actuation, energy conversion, percutaneous leads, compliance devices and biomaterials. The challenges are many and welcomed.