Percutaneous ventricular assist devices and ECMO in the management of acute decompensated heart failure

The successful treatment of acute decompensated heart failure continues to evolve with an increasing utilization of nondurable mechanical support devices. Indications for acute support have broadened to include their use as a bridge to recovery or decision (for durable ventricular assist devices [VADs] or heart transplant). Available devices have improved in terms of effectiveness, ease of insertion, and reduction in complications. The commonly used devices (intra-aortic balloon pump, TandemHeart, Impella, and extracorporeal membrane oxygenation circuit), together with their mechanisms of action, are reviewed. Current considerations for support, specific to each device, are examined and future directions and indications for percutaneous VADs are explored.