Mechanical circulatory support gaining ground as HF therapy

LOS ANGELES — Several speakers gathered to discuss emerging HF therapies at multidisciplinary panel sessions held at the American Association of Heart Failure Nurses Annual Meeting.

Of particular interest to attendees was the total artificial heart, a mechanical circulatory support system that replaces the heart as a bridge to transplantation. Cardiology Today Editorial Board member Jon Kobashigawa, MD, along with colleagues from Cedars-Sinai Medical Center in Los Angeles, addressed the multidisciplinary potential and challenges associated with this device.

Jon Kobashigawa

Traditionally, mechanical circulatory support devices were reserved for the most severe cases of HF: either NYHA class IV or ACC/AHA class D patients. However, cardiologists now have a clearer picture of the ideal candidate for the use of these systems, and the number of implants has increased notably since 2011. Newer indications for a mechanical circulatory support system include thrombosed ventricles, congenital abnormalities, cardiac malignancies and progressive right ventricular failure among patients with a left ventricular assist device.

Kobashigawa discussed the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS), a national registry of patients who are receiving mechanical circulatory support device therapy to treat advanced HF. INTERMACS profiles range from 1 (cardiogenic shock) to 7 (stable with a reasonable level of activity). Data from the registry reveals that profiles 1, 2 (progressive decline despite inotropes) and even 3 (stable but inotrope-dependent) are all potential candidates for mechanical circulatory support systems, particularly the total artificial heart.

The presenters also highlighted the resources available to patients who receive mechanical circulatory support systems, including support groups, long-term care, nutritional guidelines and counseling.

For more information:

Jocson R, Kobashigawa J, Lam L. MCS total artificial support multidisciplinary panel. Presented at: the American Association of Heart Failure Nurses Annual Conference; June 26-28, 2014; Los Angeles.

Kim L, Kobashigawa J, Velleca A. Heart transplant multidisciplinary panel. Presented at: American Association of Heart Failure Nurses Annual Conference; June 26-28, 2014; Los Angeles.

Disclosure: Kobashigawa receives research grant support from Novartis and XDx, Inc. Other speakers reported no relevant financial disclosures.