Mechanical Circulatory Support Devices in Cardiogenic Shock

TOPICAL COLLECTIONS

Guest Editor

Poonam Velagapudi

University of Nebraska Medical Center

Dr. Poonam Velagapudi, MD, MS, FACC, FSCAI is a structural and interventional cardiologist and Assistant Professor of Medicine at the University of Nebraska Medical Center (UNMC) in Omaha, Nebraska, USA. She is an Associate Program Director for the Cardiology Fellowship and Director for Digital Innovation and Social Media Strategy for the Division of Cardiovascular medicine at UNMC. She completed her Master's in Exercise Physiology with a focus on cardiac physiology at Eastern Michigan University, Michigan, USA, and completed interventional cardiology and structural cardiology fellowships at Brown University, Rhode Island, USA and Columbia University, New York, USA respectively. Dr. Velagapudi’s clinical and research interests include high risk percutaneous coronary interventions, shock and mechanical circulatory support devices, radial and large bore access, and percutaneous valvular interventions including transcatheter aortic and mitral valve replacement and MitraClip. She is passionate about improving the cardiovascular health of women by increasing their representation in clinical trials.   Dr. Velagapudi is the Chair of the Early Career Section of the American College of Cardiology (ACC) and a member of the Cohort III of the ACC ‘Leadership Academy’ program. She is a social media editor for Journal of American College of Cardiology and ACC ACCEL audio. She has authored or co-authored several manuscripts in peer reviewed journals and abstracts presented at various national and international meetings. She is a reviewer for several scientific journals related to interventional cardiology. Dr. Velagapudi received the American Heart Association’s Council on Clinical Cardiology's ‘Women in Cardiology Trainee Award for Excellence’ in November, 2014.

Collection Overview

Cardiogenic shock (CS) is defined as systolic blood pressure (SBP) <90 mm Hg for ≥30 min, or use of mechanical/vasopressor support to maintain SBP ≥90 mm Hg, or evidence of end‐organ damage such as urine output <30 mL/h, cool extremities on examination, altered mental status and/or serum lactate >2.0 mmol/L. The hemodynamic criteria for CS include a cardiac index (CI) ≤ 2.2 L/min/m2 and a pulmonary capillary wedge pressure (PCWP) ≥15 mm Hg. There are several etiologies for CS, the most common being acute myocardial infarction (AMI), and CS is associated with a high mortality when left untreated in this setting.

Several mechanical circulatory support (MCS) devices are currently available to treat CS. These include intra-aortic balloon pump (IABP), percutaneous left ventricular assist devices (PVAD) - Impella 2.5, Impella CP, Impella 5.0, and Tandem Heart, extracorporeal membrane oxygenation (ECMO), and right ventricular support devices- Impella RP and Protek Duo. It is important to understand the mechanism of action of these devices, indications for their use and the available data as appropriate device/patient selection are key to obtaining best results. It is also important to be proficient in large bore access and understand the steps of device implantation and removal to be able to implant and remove these devices safely. Access site complications can be minimized using fluoroscopy or coronary tomography angiography for access site selection and use of ultrasound and fluoroscopy for obtaining access.

In this collection, we will discuss available data for the various MCS devices, their mechanism of action, appropriate patient and device selection, steps of implantation and removal, and post implant care for best results.