Table 3. Summary of advantages, disadvantages, contraindications, and complications of short-term mechanical circulatory support devices.

Characteristics	IABP	Impella	VA ECMO	TandemHeart
Advantages	Readily available, bedside insertion, small size cannula single vascular access, less vascular injury, low cost, can tolerate without anticoagulation	Better hemodynamic support than IABP, small size cannula, bedside position adjustment, efficacy independent of rhythm, direct LV unloading	Better hemodynamic support than IABP, bedside insertion, can provide full cardiopulmonary support, efficacy independent of cardiac rhythm	Better hemodynamic support than IABP, efficacy independent of cardiac rhythm, respiratory support possible with addition of oxygenator
Disadvantages	Modest support, reduced efficacy during arrhythmias, no RV support	Risk of vascular injury, surgical cutdown for larger cannulas, no RV support, fluoroscopy needed for insertion	Risk of vascular injury, large sized cannula, may need LV unloading	Risk of vascular injury, large sized cannula, fluoroscopy needed for insertion, trans-septal puncture, no RV support
Contraindications	PVD, aortic insufficiency, aortic aneurysm, aortic dissection	Mechanical AV, LV thrombus, VSD, intolerant to anticoagulation, PVD, severe aortic stenosis, recent CVA	LV thrombus, intolerant to anticoagulation, PVD, aortic insufficiency, aortic dissection	LA thrombus, intolerant to anticoagulation, PVD, aortic insufficiency, aortic dissection, VSD
Complications	Limb ischemia, bleeding, thrombocytopenia, hemolysis, ischemic bowel, aortic rupture, balloon rupture	Limb ischemia, bleeding, hemolysis, AV injury, ventricular arrhythmia, LV perforation	Limb ischemia, bleeding, hemolysis, differential hypoxia, thromboembolism, LV dilatation, pulmonary edema, air embolism	Limb ischemia, bleeding, hemolysis, right-to-left shunt, cardiac tamponade, thromboembolism

AV, aortic valve; CVA, cerebral vascular accident; IABP, intra-aortic balloon pump; LV, left ventricle; PVD, peripheral vascular disease; RV, right ventricle; VA ECMO, venoarterial extracorporeal membrane oxygenation; VSD, ventricular septal defect.