Role of percutaneous left ventricular assist devices in preventing cerebral ischemia

Percutaneous left ventricular assist devices improve hemodynamics in acute heart failure. The devices can be deployed rapidly and with a low risk of complications, and may thereby offer potential advantages compared with surgical assist systems in the critically ill. Cerebral hypoperfusion with cerebral injury is a major challenge in acutely ill cardiac patients, especially when cardio–pulmonary resuscitation is performed. There is no indication that catheter-based left ventricular assist devices confer more cerebrovascular complications than current percutaneous angiographic and interventional procedures. Recent data suggest that microcirculation in the head may be improved during percutaneous assist device support in cardiogenic shock. Specific assessment of the effect of a percutaneous device during cardiac arrest and impaired cerebral circulation has been performed in newly published experimental protocols. The available data indicate that a percutaneous intracardiac impeller device may be able to sustain cerebral perfusion during cardiac arrest. Assessment of metabolic markers in the brain, using intracerebral microdialysis during ventricular fibrillation, indicates ischemic brain injury may be avoided during cardiac arrest lasting 20–40 min without simultaneous chest compressions. The use of percutaneous left ventricular assist devices may have the potential to prevent ischemic brain damage and improve clinical outcomes for patients with cardiac collapse and impaired cerebral circulation. Randomized clinical studies are necessary to validate these new treatment concepts.