Introduction

A left ventricular assist device (LVAD) was first successfully used to bridge a patient with postcardiotomy shock to recovery in 1966; 2 years later, a patient in cardiogenic shock was salvaged with an intra-aortic balloon pump (IABP). Research on the total artificial heart also commenced in the late 1960s. Today, we have a wide range of options for circulatory support.

The decision whether to institute mechanical support depends on the aetiology of heart failure and on the likely long-term treatment strategy. Which method is deployed is determined by the acuteness of onset of heart failure, its potential reversibility and severity, local availability as well as the duration of support required.

Invasive haemodynamic monitoring is indispensable and provides the best evidence for the requirement and the adequacy of circulatory support. The pulmonary artery catheter provides important information, including left ventricular (LV) preload, LV afterload, right ventricular (RV) after-load and cardiac output (CO) as well as providing information on the adequacy of systemic oxygen delivery.

Intra-aortic balloon pump

The IABP is the most common form of circulatory support and is used in response to many different clinical situations. The balloon catheter has two channels: one for the passage of helium gas used to inflate and deflate the balloon, the other for direct monitoring of intra-aortic blood pressure.