With acute haemodynamic compromise in the setting of myocardial insult, the aims are to restore normal haemodynamics, minimise LV filling pressure, minimise oxygen consumption, prevent remodelling and enhance myocardial salvage. Unlike MCS, pharmacological approaches increase oxygen consumption and increase the load on the left ventricle. Different methods of MCS have different effects on haemodynamics and myocardial energetics. Venous-to-aortic devices do not unload the heart or reduce oxygen consumption, whereas left ventricle-to-aorta devices do. The latter also uncouple the left ventricle and aorta, allowing for unloading of the left ventricle while restoring arterial blood pressure and flow.
The science behind acute ventricular and myocardial unloading
D Burkhoff
Interventional Cardiology Review 2017;6-8