Table 1.

Mechanical circulatory support uses, device types, and considerations

Durable Mechanical Circulatory Support
Use Categories	Uses	Considerations
Left ventricular support	Can be for bridge to transplantation, bridge to candidacy, or as destination therapy	Most common durable MCS category by far
Biventricular support	Used in severe BiV failure
Biventricular replacement device	Used primarily for bridge to transplantation or bridge to candidacy (4)	Replaces the native ventricles and the four valves
Right ventricular support	Used for isolated RV failure
Device types	Considerations
Axial flow devices	The most used devices for many years (1) Mechanical bearings may lead to reduced durability Second-generation devices
Centrifugal flow devices	Designed for improved durability, smaller size, and improved blood flow compared with axial flow pumps Can be implanted within the pericardium Third-generation devices
Pneumatic displacement pump devices	Require larger drivelines than axial or centrifugal flow devices TAH is an example
Temporary Mechanical Circulatory Support
Device types	Uses	Considerations
Intra-aortic balloon pump	High-risk PCI Acute decompensated heart failure Cardiogenic shock	Widely available Easily inserted and maintained Limited hemodynamic support
Axial flow pumps	High-risk PCI Acute decompensated heart failure Cardiogenic shock	Placed percutaneously or surgically Some devices can supply high levels of hemodynamic support
Centrifugal flow pumps	Cardiogenic shock Cardiopulmonary bypass during surgery RV support when LVAD is implanted	Placed percutaneously or surgically Can be used for prolonged periods
Venoarterial ECMO	Cardiogenic shock Cardiac arrest	Placed percutaneously or surgically Can provide respiratory support

MCS, mechanical circulatory support; LVAD, left ventricular assist device; BiVAD, biventricular assist device; TAH, total artificial heart; RVAD, right ventricular assist device; RV, right ventricular; BiV, biventricular; PCI, percutaneous coronary intervention; ECMO, extracorporeal membrane oxygenation.