Table 1

Suggested Indications for Percutaneous MCS

IndicationComments
Complications of AMIIschemic mitral regurgitation is particularly well-suited to these devices as the hemodynamic disturbance is usually acute and substantial. Acutely depressed LV function from large AMI during and after primary PCI is an increasing indication for temporary MCS use. Cardiogenic shock from RV infarction can be treated with percutaneous right ventricular support.
Severe heart failure in the setting of nonischemic cardiomyopathyExamples include severe exacerbations of chronic systolic heart failure as well as acutely reversible cardiomyopathies such as fulminant myocarditis, stress cardiomyopathy, or peripartum cardiomyopathy. In patients presenting in INTERMACS profiles 1 or 2, MCS can be used as a bridge to destination VAD placement or as a bridge to recovery if the ejection fraction rapidly improves (108).
Acute cardiac allograft failurePrimary allograft failure (adult or pediatric) may be due to acute cellular or antibody-mediated rejection, prolonged ischemic time, or inadequate organ preservation.
Post-transplant RV failureAcute RV failure has several potential causes, including recipient pulmonary hypertension, intraoperative injury/ischemia, and excess volume/blood product resuscitation. MCS support provides time for the donor right ventricle to recover function, often with the assistance of inotropic and pulmonary vasodilator therapy (109).
Patients slow to wean from cardiopulmonary bypass following heart surgeryAlthough selected patients may be transitioned to a percutaneous system for additional weaning, this is rarely done.
Refractory arrhythmiasPatients can be treated with a percutaneous system that is somewhat independent of the cardiac rhythm. For recurrent, refractory, ventricular arrhythmias, ECMO may be required for biventricular failure.
Prophylactic use for high risk PCIParticularly in patients with severe LV dysfunction (EF <20% to 30%) and complex coronary artery disease involving a large territory (sole-remaining vessel, left main or three vessel disease) (94,95,98).
High-risk or complex ablation of ventricular tachycardiaSimilar to HR-PCI, complex VT ablation can be made feasible with percutaneous support. MCS use allows the patient to remain in VT longer during arrhythmia mapping without as much concern about systemic hypoperfusion.
High-risk percutaneous valve interventionsThese evolving procedures may be aided with the use of MCSs.