Mechanical Circulatory Support

Mechanical Circulatory Support

Dave Nagpal (Western University, Canada)
Copyright: © 2015 |Pages: 24
DOI: 10.4018/978-1-4666-8603-8.ch028
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An increasingly important component of the therapeutic armamentarium in the treatment of cardiac and cardiopulmonary pathology, utilization of mechanical circulatory support allows clinicians to help sicker patients with more advanced disease states. A plethora of options exist, each with multiple implant techniques and management strategies. To optimize patient care in a cost-conscious environment, one must understand the advantages and disadvantages of each permutation, and have an algorithmic approach for the selection and application of available technologies. This chapter aims to provide such an understanding by reviewing surgical implant techniques and peri-operative management strategies for a number of commonly used short-term and durable devices.
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Historically, the advancement of cardiac surgery has paralleled the development of MCS. The earliest available device was ECMO, in the form of cardiopulmonary bypass, which allowed the development of safer surgical treatment of a wide range of cardiac pathology. Numerous heart and/or lung function replacement or assist devices have been developed over the past 60 years, which in turn has allowed the continual refinement of therapy in increasingly older and more sick patients.

Current common MCS devices may be categorized into cardiac and cardiopulmonary support systems, the latter comprised of ECMO. Cardiac support systems may be divided into short-term and durable devices, which may be further subcategorized by a number of characteristics including uni- or bi-ventricular assistance, partial or full support capability, and percutaneous or surgical implantation.

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