2015 Consensus Recommendations on Percutaneous Mechanical Circulatory Support Devices

ProtectedPCI
April 19, 2016

The availability of percutaneous mechanical support (MCS) devices such as Impella®, TandemHeart, and ECMO requires cardiologists to understand each device, its treatment strategies and recommendations for use in clinical care settings.  The 2015 Consensus Statement on Percutaneous Mechanical Support Devices in Cardiovascular Care by Rihal et al. 2015 provides this guidance.

The first conclusion states “MCS devices provide superior hemodynamic support compared to pharmacologic therapy.  This is particularly apparent for the Impella and TandemHeart devices.  These devices should remain available clinically and be appropriately reimbursed.”

The second conclusion focuses on cardiogenic shock and notes “early placement of an appropriate MCS may be considered in those who fail to stabilize or show signs of improvement quickly after initial interventions.”

The authors’ third conclusion states “MCS may be considered for patients undergoing high-risk PCI, such as those requiring multivessel, left main, or last patent conduit interventions, particularly if the patient is inoperable or has severely decreased ejection fraction or elevated cardiac filling pressures.”  Recommendations for use of MCS in high-risk PCI are summarized below:

 Clinical Suggestions* for Mechanical Circulatory Support Use in High-Risk PCI

Clinical Criteria**Uncomplicated PCIPotentially Complicated PCI
Normal or EF>35% No MCS use IABP/Impella as back up
EF<35% or recent decompensated HF IABP/Impella as back upImpella or Tandemheart, depending on anatomy, expertise, availability ECMO for associated hypoxemia or RV§ failure

* Table adapted from Table 2, Rihal et al. 2015. Suggestions based on clinical and anatomic conditions. MCS has the potential to provide greatest benefit in situations of hemodynamic compromise or collapse.

**Clinical criteria includes patients with left main or multivessel disease, last remaining vessel

 †EF=ejection fraction

 ‡HF=heart failure

  • RV=right ventricle

The authors’ final conclusion states “Early analyses suggest cost-effectiveness of MCS for emergent use.”

Next Steps:

  1. Read the original 2015 consensus statement by Rihal et al. 2015
  2. Read more about Selected Consensus Recommendations on Hemodynamic Effects, Risks of Percutaneous Mechanical Circulatory Support Systems
  3. Learn more about the use of Impella 2.5 for PCI