The role of Mechanical Circulatory Support for Advanced Heart Failure

by admin-blog-kh | October 28, 2025 8:09 am

Summary 

Advanced Heart Failure is a serious condition with high morbidity and mortality rates. Advanced medication therapies may not be adequate and in some cases, heart transplantation may be the only option. However, not enough cadaver hearts are available for transplant, and this is a global problem. To overcome the situation and help effectively treat people with advanced heart failure[8], various Mechanical Circulatory Support devices have been developed over time. In this article, we will learn more about them.

Introduction to Heart Failure 

Heart Failure (HF) is a fairly common condition around the world, and shows a high morbidity and mortality rate. In the US alone, 5.8 million people are affected according to the Centre for Disease Control. Similar numbers as a percentage of the population can be expected in India as well, given the prevalence of coronary heart disease[9], rheumatic heart disease, obesity, diabetes and hypertension in India. When the patient is suffering from Refractory End-stage Heart failure, simply called advanced heart failure, heart transplantation[10] from a cadaver was the gold standard in the past. However, there is a perennial shortage of cadaver hearts for transplantation either in India, or anywhere abroad. That is why, Mechanical Circulatory Support (MCS) devices have evolved over time to help treat people with Advanced Heart Failure, better.

What is Advanced Heart Failure?

Advanced Heart Failure (AHF) is not a single event or condition. According to cardiologists, there is a wide spectrum of conditions and profiles of people suffering from Advanced Heart Failure. On one end, there are people with chronic, stable Heart Failure who can manage some of their daily activities, while on the other end, there are people in acute cardiogenic shock. Mortality rates of these people also varies depending on the profile. So, in the absence of emergency heart transplantation, an MCS device helps reduce mortality rates and prolong life.

Stages of Heart Failure 

The American College of Cardiology (ACC) and American Heart Association (AHA) have categorized HF into 4 stages, each requiring a different strategy for Outpatient Management.

• Stage A: People at risk of HF but with no structural heart disease or symptoms of HF. The management strategy is to eliminate or reduce the risk factors as much as possible.
• Stage B: People with structural heart disease but with no symptoms or signs of asymptomatic HF. HFrEF – Heart failure with reduced ejection fraction – is one type of heart failure. In this, the left ventricle does not pump blood out to the body as efficiently as it should. The management strategy for Stage B persons is medication under specific guidelines, with minimum use of diuretics.
• Stage C: People with structural heart disease and recent or ongoing symptoms or signs of HF (symptomatic HF). Here, management strategy includes medication under specific guidelines, the use of diuretics, and the use of ICD/CRT devices (Implantable cardioverter defibrillators and cardiac resynchronization therapy).
• Stage D: Refractory or end-stage HF which will require advanced therapies. Management strategy includes the use of inotropic drugs, heart transplant and MCS/LVAD devices.

Cardiogenic Shock in Stage D Heart Failure 

Stage-D HF persons can suffer from a life-threatening condition called Cardiogenic Shock. In this, the heart is suddenly unable to pump enough blood to the rest of the body. This is generally caused by a heart-attack, however, not all heart-attack victims may experience cardiogenic shock[12]. The condition is marked by hemodynamic parameters. This includes systolic blood-pressure of less than 80-90 mmHg, mean arterial-pressure that is 30 mmHg lower than the baseline value, cardiac index of less than 1.8L/min/m2 without support or less than 2.2 L/min/m2 with support, and higher left or right ventricle filling pressures with clinical symptoms of hypoperfusion.

Mortality rate for people in cardiogenic shock varies from 30% to 50%. In such a scenario, Mechanical Circulatory Support (MCS) devices are inevitable for effective treatment.

Temporary MCS for Cardiogenic Shock 

Depending on how long the device is required for the person, MCS devices are classified as temporary MCS for short-term use, and durable MCS for long-term use. Again, depending on the pumping mechanism, the pumps are classified as centrifugal pumps, axial flow pumps and volume displacement pumps.

Temporary MCS are again of two types: percutaneous, where they are implanted under the skin, and extracorporeal, where they remain outside the body. There are various percutaneous and extracorporeal temporary MCS that are widely used today. They help in stabilizing the heart, achieving myocardial recovery (partial to total recovery of heart function) and recovery of functionality in the brain, liver and kidneys.

Percutaneous temporary MCS devices are of different types, based on:

1. Pneumatic counter pulsation (models include IABP and Pulse Cath iVAC)
2. Microaxial flow pumps (models include Impella and HeartMate percutaneous heart pump)
3. Centrifugal pumps (models include Tandem Heart, VA-ECMO, Centri Mag, and RotaFLow)

These devices are surgically implanted using central cannulation (cannulas are hollow, stainless tubes) or via the femoral or axillary artery.

Temporary MCS Devices widely used

There is a wide range of temporary MCS Devices used in India and worldwide. Each one of them can be the subject of an entire blog, so we are only listing those devices here.

• IABP – Intra Aortic Balloon Pump or Aortic Pulsatile Pneumatic Pump
• iVAC2L-pVAD – Left Ventricle to Ascending Aorta Pulsatile Flow, Extracorporeal Pneumatic Pump
• Impella Pump[14] – Continuous Flow, Microaxial Left Ventricle to Ascending Aorta Pump
• Tandem Heart – Left Atrial to Aorta Continuous Flow, Extracorporeal Centrifugal Pump
• Peripheral VA-ECMO (Right Atrial to Aorta Continuous Flow, Extracorporeal Centrifugal Pump)
• Impella LD and Impella 5.5 Pumps – Surgically Implanted Temporary MCS for Left/Right and Biventricular Support[15]
• Centri Mag and RotaFLow – Continuous Flow, Extracorporeal Centrifugal Pump
• Central VV and VA-ECMO

Decision-Making for Temporary MCS Device Selection 

So how will the doctors decide which is the best device to be used for that particular person?

• Doctors from multiple disciplines will be involved. This includes specialized HF cardiologists, cardiac surgeons specializing in MCS and transplant surgery[16], and interventional cardiologists.
• The person-specific factors include their vascular anatomy, cost of procedures (this matters in low- and middle-income countries), his/her comorbidities, the severity of cardiogenic shock, the procedure time involved, and availability of specialized cardiac healthcare[17].
• The success-rate in the use of these devices depends on timely decision-making, how well the resources are prioritized and how well the future advanced therapies are determined for this person.

All these go a long way in achieving positive outcomes.

If you or a loved one is facing advanced heart failure and want to explore options like mechanical circulatory support, trust the expert cardiology team at Kauvery Hospital. With branches in Chennai, Hosur, Salem, Tirunelveli, and Trichy, Kauvery Hospital offers advanced heart care and personalised treatment plans to improve your heart health[18] and quality of life.

Frequently Asked Questions About Mechanical Circulatory Support (MCS) 

What is Mechanical Circulatory Support (MCS)?

Mechanical Circulatory Support (MCS) refers to devices that help the heart pump blood when it becomes too weak to function on its own. They are used in patients with advanced heart failure to stabilize circulation, improve organ function, and extend life.

Who needs a Mechanical Circulatory Support device?

MCS is recommended for patients with severe or end-stage heart failure who no longer respond to medications. It’s often used as a bridge to heart transplantation or as a long-term therapy when transplant is not possible.

What are the types of Mechanical Circulatory Support devices?

MCS devices can be temporary (used during emergencies like cardiogenic shock) or durable (used for long-term support). Common devices include IABP, Impella, Tandem Heart, and LVAD systems.

How does Mechanical Circulatory Support improve patient outcomes?

By restoring blood flow and reducing strain on the heart, MCS devices improve organ function, reduce mortality, and enhance recovery chances until transplantation or permanent recovery.

Are MCS devices a permanent solution for heart failure?

Some patients use MCS devices temporarily until a transplant, while others rely on them long-term (destination therapy). The approach depends on the patient’s heart condition and overall health.

 

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet, Vadapalani & Radial Road), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and paediatric trauma care.

Chennai Alwarpet – 044 4000 6000 • Chennai Vadapalani – 044 4000 6000 • Chennai Radial Road – 044 6111 6111 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4077777 • Trichy – Tennur – 0431 4022555 • Maa Kauvery Trichy – 0431 4077777 • Kauvery Cancer Institute, Trichy – 0431 4077777 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 68011

 

Source URL: https://www.kauveryhospital.com/blog/heart-health/the-role-of-mechanical-circulatory-support-for-advanced-heart-failure/

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