Progress in mechanical circulatory support

Mechanical circulatory support is an important aspect of the management of patients with severe heart failure. Such support improves survival when treatment with intravenous inotropes or vasodilators, intra-aortic balloon counterpulsation and mechanical ventilation has failed. Technological advances in ventricular assist devices have reduced the risk of postoperative complications. However, risk stratification prior to device implantation is essential for reducing complications over both the short and long term. As knowledge about cardiovascular disease and the range of mechanical devices available continue to develop, the challenge for clinicians will be to use clinical findings to select the device that is most likely to benefit the individual patient. This article describes the circulatory support devices currently available for use in patients, the indications for their use, their beneficial effects on ventricular function, and the advantages and disadvantages of each particular device.