This review highlights the spectrum of available therapies for acute and chronic heart failure patients and circulatory shock in general. The flexible nature of MCS configurations allows for an individualized approach driven by the ultimate goal of achieving organ recovery or bridging to long-term options. Intensivists, when faced with severe cardiac failure, especially in younger patients, may have to consider MCS as a viable option and initiate timely referrals. Similarly in patients with chronic heart failure, timely insertion of long-term VADs prior to development of irreversible end-organ dysfunction will minimize postoperative morbidity and eliminate the need for short-term temporary bridging mechanical support. Some patients will need short-term mechanical right heart support with a temporary RVAD and in others a long-term BiVAD may be inevitable and customized implantable RVADs may become a reality in future. Both VAD and total artificial heart technology will see many more refinements with time and it is difficult to predict which of these devices will prove to be a perfect bridge to heart transplant or destination. Whilst these technologies may seem excessively complex and expensive, this was once said of dialysis. In the current era, in an appropriately resourced setting, no eligible patient should die on maximal medical therapy without MCS being considered.
Ms Lynette Munck for administrative support and proof reading the manuscript. John Fraser currently holds a Health Research Fellowship awarded by the Office of Health and Medical Research, Queensland, Australia. The authors would like to recognize the financial assistance provided by the National Health and Medical Research Council (APP1079421). The contents are solely the responsibility of the authors and do not reflect the views of the NHMRC.
Crit Care. 2016;20(66) © 2016 BioMed Central, Ltd.
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