According to the 2013 ISHLT guidelines for acute cardiogenic shock, when is mechanical circulatory support (MCS) indicated in the treatment of myocardial infarction (MI, heart attack)?

Updated: May 07, 2019
  • Author: A Maziar Zafari, MD, PhD, FACC, FAHA; Chief Editor: Eric H Yang, MD  more...
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Answer

In its 2013 guidelines for mechanical circulatory support, the ISHLT recommended long-term MCS for acute cardiogenic shock in the following patient settings (Class IIa, level of evidence: C) [133] :

  • When ventricular function is deemed unrecoverable or unlikely to recover without long-term device support
  • Severely ill and unable to maintain normal hemodynamics and vital organ function with temporary MCS, or cannot be weaned from temporary MCS or inotropic support
  • Has the capacity for meaningful recovery of end-organ function and quality of life
  • Absence of irreversible end-organ damage

Additional recommendations include [133] :

  • If possible, delay permanent MCS in the setting of an acute infarct involving the left ventricular (LV) apex. (Class IIb, level of evidence: C)
  • Perform echocardiography as part of the preoperative assessment and routinely at regular postoperative intervals to evaluate for signs of myocardial recovery and optimal MCS device function. This imaging modality may be used to set optimal pump parameters. (Class I, level of evidence: B)
  • In addition, perform echocardiography to evaluate suboptimal MCS device function or in the presence of clinical signs of circulatory dysfunction, including congestive or low output symptoms. (Class I, level of evidence: B)

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