Mechanical Circulatory Support Oakville
Mechanical Circulatory Support
What is Mechanical Circulatory Support (MCS)?
Mechanical Circulatory support provides life-saving support for patients with advanced heart or pulmonary failure. These mechanical circulatory support (MCS) devices can be used either temporarily or permanently, to assist the pumping function of the heart. There are many different types of mechanical circulatory support devices, indicated for different clinical situations.
What is a Left Ventricular Assist Device?
A left ventricular assist device (LVAD) is a type of mechanical circulatory support device, that helps the lower left chamber (left ventricle) pump blood from the heart to the rest of the body. It is used in patients whose hearts have a severely reduced pumping function (heart failure). The device assists the left ventricle in providing oxygen rich blood to the rest of the body, improving both quality of life and survival.
The left ventricular assist device is implanted surgically, into the base of the lower left chamber (left ventricle). It has a tiny propeller within it that generates a force that moves blood from the left ventricle, through an outflow graft, and into the aorta. The aorta is a large blood vessel that takes the blood from the heart and delivers this oxygen-rich blood to the rest of the body. The LVAD basically acts to bypass the failing left ventricle, and pumps blood more efficiently out of the heart.
The Bridges of LVADs
Left ventricular assist devices (LVADs) can be used in 4 ways:
Bridge to Decision:
Some patients need short term mechanical circulatory support to buy time to determine if a durable VAD is a viable option. These are typically patients who present in acute critically ill states, such as cardiogenic shock.
Bridge to Transplant:
Some patients need short term mechanical circulatory support while they await availability of a cardiac transplantation. This provides them with improved quality of life, and functional improvement.
Bridge to Recovery:
Some patients recover their pumping function after receiving a mechanical circulatory support device, and in due time, the device can be safely explanted.
Destination Therapy:
Some patients who are not candidates for a cardiac transplantation, receive the mechanical circulatory support device as a permanent resource to provide improved quality of life, and survival.
Why Is Early Referral To An Advanced HF Cardiologist Important?
Median Survival (Years)
With every re-hospitalization for Heart Failure, there is a stepwise decrease in survival.
By the time a patient is hospitalized 4x, the survival is only 6 months or less!
Early Referral to an Advanced HF Cardiologist, can change this trajectory, by optimizing medical, device and surgical therapeutic strategies, that improve quality of life and survival.
Source: Setoguchi S, et al. Repeated hospitalizations predict mortality in the community population with heart failure. Am Heart J. 2007;15:154(2):260-266.
When To Refer To An Advanced Heart Failure Cardiologist
ANY of the following should trigger a referral to an Advanced HF Cardiologist:
I
IV Inotropes
N
NYHA IIIB/IV symptoms or persistently elevated natriuretic peptides
E
End organ dysfunction (Creatinine >1.8 mg/dL (159 umol/L) or BUN >43 mg/dL (15 mmol/L))
E
Ejection Fraction ≤ 35%
D
Defibrillator Shocks
H
Hospitalizations for HF > 1
E
Edema (elevated PA pressure) despite escalating diuretics
L
Low blood pressure, high heart rate
P
Prognostic Medications – progressive intolerance or down-titration GDMT
Additional Patient Considerations
- Cardiac resynchronization therapy (CRT) Non-responder
- Limited physical activity or impaired quality of life.
Source: Yancy CW, et al. 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues about Heart Failure with Reduced Ejection Fraction: A Report of the American College of Cardiology Taks Force on Expert Consensus Decision Pathways. J AM Coll Cardiol. 2018;71(2):201-230. 
Frequently Asked Questions
This is absolutely not true!! Clinical trials have demonstrated that heart failure patients who previously could not walk very far due to exercise intolerance, were able to walk the equivalent of 4 football fields in 6 minutes, within 6 months of receiving a LVAD Device!!
Source: Mehra MR, Uriel N, Naka Y, et al. A Fully Magnetically Levitated Ventricular Assist Device – Final Report. N Engl J Med. 2019;380:1618-1627.Absolutely not true! The evolution of LVAD devices over the past few decades has been pretty incredible. While it is true, the original LVADs (Heartmate XVE) were quite clunky and large, much has changed over the years. The latest version, the HeartMate 3, can fit in the palm of your hand, and only weigh 200 grams!
SourcesBenjamin EJ, et al. American Heart Association Statistics Committee and Stroke Statistics Subcomittee. Heart Disease and Stroke Statistics – 2017 Update. A Report from the American Heart Association. Circulation. 2017;135(10):e146-e603.
American Heart Association. Advanced Heart Failure website. https://www.heart.org/en/health-topics/heart-failure/living-with-heart-failure-and-managing-advanced-hf/advanced-heart-failure.Access June 15, 2023.
Setoguchi S et al. Repeated hospitalizations predict mortality in the community population with heart failure. Am Jeart J. 2007;154(2):260-266.
Sidney S, Go A. Jaffe M. Associatio between aging of the US population and heart disease mortality from 2011 to 2017. JAMA Card. 2019;E1-E7.
Yancy CW, Januzzi JL Jr, Allen LA, Buttler J, Davis LL, Fonarow GC et al. 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal issues About Heart Failure with Reduced Ejection Fraction: A Report of the American College of Cardiology Task Force on Expert Consenus Decision Pathways. J Am Coll Cardiol. 2018;71(2):201-230.Shavelle DM, Desai AS, Abraham WT et al. Pulmonary Artery Pressure-Guided Therapy for Ambulatory Heart Failure Patients in Clinical Practice: 1 year Outcomes from the CardioMEMS Post Approval Study. Presented at: ACC; March 17, 2019.
Still have a question about mechanical circulatory support? Speak to your doctor about a referral to the Chahal Cardiovascular Centre for an Advanced Heart Failure consultation.
