Mechanical Circulatory Support in Patients with End-Stage Heart Failure: a Literature Review (Part 1)

Chronic heart failure (CHF) is a progressive and irreversible syndrome that develops against the background of structural and functional disorders of the heart. It is accompanied by a decrease in cardiac output, pressure overload and a high level of hospitalizations, which makes CHF one of the key medical and social problems of our time. In recent decades, the prevalence of CHF has been steadily increasing, especially among the elderly population, which is associated with an increase in life expectancy and an improvement in the quality of medical care. According to forecasts, by 2050 the number of patients will increase by 50-60% compared to 2010. The terminal stage of CHF is characterized by an extremely unfavorable prognosis: survival does not exceed 25-30%. Heart transplantation (HT) remains the only radical treatment method that can significantly improve survival and quality of life. However, the shortage of donor organs and the growing number of patients necessitate the use of mechanical circulatory support (MCS) as a temporary or long-term alternative. MPC systems act as a “bridge” to transplantation, allowing for hemodynamic stabilization and organ function support before surgery. The most common short-term support technologies are extracorporeal membrane oxygenation (ECMO), intra-aortic balloon pump (IABP), and temporary axial pumps (Impella, TandemHeart). ECMO provides both respiratory and hemodynamic support, but is associated with a high risk of complications and relatively low survival. IABP is the most accessible method, improving coronary perfusion, but provides limited support. Impella devices demonstrate higher efficiency, unloading the left ventricle and improving systemic hemodynamics, while being characterized by fewer complications. TandemHeart provides a comparable effect, but requires a more complex installation technique. The choice of MPC method depends on the patient’s condition, the severity of multiorgan dysfunction, the availability of equipment, and the qualifications of the specialists. Current research confirms that a combination of different devices (e.g., ECMO and Impella) can improve outcomes. Thus, mechanical circulatory support occupies a central place in the treatment of terminal heart failure in conditions of limited donor resources, allowing to gain time before transplantation and reduce mortality on the waiting list.