Mechanical circulatory support of the failing heart

Over the past 30 years, there have been significant pharmacological and technological advances in the treatment of cardiogenic shock. Although most patients who develop cardiogenic shock can be effectively treated with conventional therapy, including inotropic and vasodilating drugs and intra-aortic balloon pumps, a significant number of patients have ventricular failure that is refractory to conventional therapy. For these patients, the prognosis is poor unless the deleterious effects of cardiogenic shock can be reversed. For some, cardiac revascularization or the repair of mechanical defects reverses the hemodynamic deterioration. However, there are subgroups of patients in whom an advanced form of mechanical circulatory support is necessary for myocardial recovery or in whom recovery will never occur, but who may be candidates for cardiac transplantation.