Percutaneous Ventricular Assist Devices: New Deus Ex Machina?

Figure 3

Schematic clinical uses of percutaneous ventricular assist devices (VAD). PCI: percutaneous coronary intervention, ACLS: acute cardiac life support, IABP: intra-aortic balloon pump, pVAD: percutaneous ventricular assist device, sVAD: surgical ventricular assist device, ECLS: extracorporeal life support. Utility of pVADs stretches from prophylactic use in high-risk PCI to immediate life-saving implantation during cardiopulmonary arrest. In cardiogenic shock especially after myocardial infarction, clinical assessment is necessary and current guidelines favour inotropic support with IABP counterpulsation. pVAD or ECLS implantation completes the management when then patient deteriorates. In case of further decline one should think of sVAD as well as heart transplantation.