ABC | Volume 111, Nº1, July 2018

Special Article Ayub-Ferreira Guidelines for MCS of the BSC Arq Bras Cardiol. 2018; 111(1):4-12 Recommendations for extracorporeal membrane oxygenation implantation Recommendation Class Level of evidence Bridge to decision or recovery I C Bridge to transplantation IIa C Recommendations for implantation of paracorporeal circulatory pumps Recommendation Class Level of evidence Bridge to decision or recovery IIa C Bridge to transplantation IIa C Recommendations for long-term mechanical circulatory support devices as bridge to transplant Recommendation Class Level of evidence Systolic heart failure - INTERMACS levels 2 and 3 Class IIa C Systolic heart failure - INTERMACS level 4 Class IIb C Systolic heart failure -INTERMACS levels 1, 5, 6 and 7 Class III C Recommendations for long-term mechanical circulatory support devices as destination therapy Recommendation Class Level of evidence Systolic heart failure - INTERMACS 3 Class IIa B Systolic heart failure - INTERMACS 2 C Systolic heart failure - INTERMACS 4 Class IIb C Systolic heart failure - INTERMACS 1, 5, 6 e 7 Class III C Types of percutaneous circulatory devices Impella ® Impella device is composed of a continuous axial flow pump, that aspirates blood directly from the left ventricle and directs it to the aorta (works in series with left ventricle). It allows the flow of 2.5 L/min (Impella® 2.5), 4.0 L/min (Impella® CP) or 5.0 L/min (Impella® 5.0). The model currently available in Brazil is Impella® CP. 24,27 TandemHeart™ TandemHeart™ system is composed of a centrifugal extracorporeal pump, a femoral cannula, a transseptal cannula and a control console. It pumps blood from the left atrium through a transseptal cannula to the ileo-femoral arterial system. Both TandemHeart ™ and the left ventricle work in parallel and contribute to aortic blood flow. 24,27 Extracorporeal membrane oxygenation Definition, types and benefits Extracorporeal membrane oxygenation (ECMO) is an invasive temporary mechanical support that provides partial or total cardiopulmonary support for patients with cardiogenic shock and/or acute respiratory insufficiency. There are two types of ECMO – venoarterial and venovenous. With quick installation technology, ECMO promotes rapid reversal of circulatory failure and/or anoxia. Other conventional centrifugal pumps may be used with the same purpose. Paracorporeal circulatory support Definition, types and benefits Paracorporeal circulatory support devices are surgically implanted pumps that promote hemodynamic support in individuals with refractory cardiogenic shock with high mortality risk. A CentriMag® is a continuous flow, magnetically levitated centrifugal bloodpump. It provides up to10L/minuteof blood flow and low shear stress, promoting low thrombogenicity, moderate anticoagulation levels and minimum hemolysis during support. 24 Berlin Heart EXCOR® is a pulsatile-flow pump that provides up to 8 L/min of blood flow, with batteries connected to a transport system, allowing an up to ten hours of patient’s mobility. Long term devices Types of long-termmechanical circulatory support devices Due to technological progress, advances in long-term MCSD models have occurred during the last years, regarding pumping system and flow type, enabling its reduction in size, greater efficiency and lower complication rates (Figure 1). The long-term MCSDs available in Brazil are described in Chart 6. Indications and contraindications In making decision process for long-term MCSDs, some important factors should be considered. In case of bridge to transplantation, transplant waiting time should be taken into account; for waiting time shorter than 30 days, there would be a low benefit-cost ratio. Also, the use of these devices in INTERMACS level 2 patients may have unfavorable results. 8