An expert consensus statement released today by the Society for Cardiovascular Angiography and Interventions (SCAI), American College of Cardiology (ACC), Heart Failure Society of America (HFSA) and The Society of Thoracic Surgeons (STS) provides new guidance to help physicians match the right device with the right patient. The statement has been endorsed by the American Heart Association (AHA), Cardiological Society of India (CSI) and the Latin American Society of Interventional Cardiology (SOLACI). The Canadian Association of Interventional Cardiology (CAIC) has affirmed the value of the statement.
To develop the new recommendations, a panel of experts reviewed scientific data on all of the available devices, including intra-aortic balloon pumps (IABP), left atrial to aorta assist devices (TandemHeart), left ventricle to aorta assist devices (Impella), extracorporeal membrane oxygenation (ECMO) as well as methods for right-sided heart support. The expert panel also reviewed indications for percutaneous mechanical circulatory support, including complications of heart attack, high-risk angioplasty and stenting, and advanced heart failure and cardiogenic shock.
Based on the available data and anticipated benefits and risks, the panel determined percutaneous mechanical circulatory support provides superior circulatory support compared to medical therapy, especially when using left ventricular assist devices. Early placement of mechanical circulatory support can benefit patients in cardiogenic shock when initial interventions fail to stabilise the patient. Mechanical circulatory support may also benefit high-risk PCI patients and certain patients with acute decompensated heart failure whose symptoms are worsening despite treatment. Mechanical circulatory support may also be used in patients who failed to wean off a heart-lung bypass machine. The evidence does not support routine use of mechanical circulatory support in heart attack patients.
The expert consensus statement also highlights emerging treatment opportunities, such as for patients undergoing percutaneous valve replacement who have severe, non-operable valve disease, and some patients undergoing electrophysiological procedures. Currently, most percutaneous MCS devices cannot be used in children due to size limitations, but the authors note this is an important area for future development. Registries and randomized controlled trials are also critically needed to compare different devices and treatment strategies across patient populations.
Charanjit S Rihal, MD—chair of the Division of Cardiovascular Diseases at the Mayo Clinic, Rochester, USA, and lead author of the paper—says: “Percutaneous mechanical circulatory support is revolutionizing the treatment of high-risk cardiac patients. In certain patients, these devices can mean the difference between recovery and the need for heart transplant or death, and they may be used to maintain hemodynamic stability during interventional procedures and as a bridge to longer-term treatment. The new consensus statement will help physicians select devices for the patients who are most likely to benefit.”
The paper, titled “SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Cardiac Assist Devices in Cardiovascular Care,” is co-published in Catheterization and Cardiovascular Interventions, the Journal of the American College of Cardiology and the Journal of Cardiac Failure.