PAPERS

Hemodynamic Support: Science and Evaluation of the Assisted Circulation with Percutaneous Assist Devices

D Burkhoff
Intervent Cardiol Clin 2013,2:407–416

Pathophysiological mechanisms the lead to hemodynamic abnormalities in cardiogenic shock (including hypotension, hypoperfusion and elevated venous pressures) are reviewed within the framework of pressure-volume analysis. This approach provides the foundation for understanding how different modes of circulatory support impact key cardiovascular parameters in various clinical settings. Four fundamentally different modes of circulatory support have been reviewed, including aortic counterpulsation, left atrial-to-arterial pumping, right atrial-to-arterial pumping and left ventricular-to-aortic pumping. Each approach has a distinct hemodynamic fingerprint with regard to effects on the ventricular pressure-volume loop and key hemodynamic parameters. Such understanding may help guide the choice of which device is most appropriate for a given clinical setting and also has the potential to guide future researchers in optimization of therapies, help generate hypotheses for clinical trials and help guide the choice of device for specific clinical trials that will ultimately provide evidence required to guide therapeutic decision making.

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