What is mechanical circulatory support (MCS)?
Mechanical circulatory support (MCS) is a way to use devices to help the heart pump blood when it can no longer do so well on its own.
MCS may be used to support your heart in different situations:
- Bridge to decision: While your care team decides on the best treatment plan
- Bridge to transplant: While you wait for a donor heart
- Destination therapy: For the rest of your life, if you’re not a candidate for heart transplant
- Temporary support: In emergencies or during high-risk procedures
Who may need mechanical heart support?
You may need MCS if you have:
- Advanced heart failure that’s not responding to medication, even though you’re following your treatment plan
- Frequent hospital stays because of your heart failure symptoms
- Low ejection fraction, which is a measure of how well your heart is pumping blood (typically under 25% for MCS)
- Poor quality of life
MCS is also used in:
- Cardiogenic shock, when your heart suddenly can’t pump enough blood to your body, which may be caused by a heart attack
- High-risk cardiac surgery (post-cardiotomy heart failure)
- Life-threatening heart conditions like rhythm disorders and severe cardiopulmonary failure
What are types of mechanical circulatory support devices?
The options for MCS devices vary based on your needs and other factors.
Short-term MCS devices (temporary)
Short-term MCS devices serve as temporary heart pumps. They include:
- Right ventricular assist device (RVAD): RVADs support only the right side of your heart. They are less common.
- Biventricular assist device (BiVAD): BiVADs support both ventricles and are usually used as a bridge to transplant.
- Impella® and Impella RP: These small pumps are inserted with a catheter (thin tube) through an artery. They are most often used during high-risk procedures or for cardiogenic shock.
- Intra-aortic balloon pump (IABP): IABPs provide support during acute heart failure. They help improve blood flow by inflating and deflating in a specific rhythm.
- Extracorporeal membrane oxygenation (ECMO): This treatment provides support outside of your body for both your heart and lungs. It’s used in critical care for severe cardiopulmonary failure.
- Tandem heart for right ventricle support: These take blood from the right atrium and move it to the pulmonary artery.
- Centrimag: These pumps can support the left, right or both ventricles for up to 30 days.
Long-term MCS devices
Long-term MCS devices support your heart for longer time periods. They are also called durable MCS devices. They include:
- Left ventricular assist device (LVAD): LVADs support the left side of your heart. They may be used as a bridge to transplant or as destination therapy.
- Total artificial heart (TAH): TAHs replace both ventricles. They may be used while you are waiting for a heart transplant.
How do providers decide if you need MCS?
To see if MCS might be a good option for you, a team of experts evaluates your heart failure. The team may include a heart failure cardiologist, cardiac surgeon, social worker and other professionals, depending on your health.
They may recommend various tests, including:
- Echocardiogram: To see how well blood is moving through your heart
- Left heart catheterization: To see if the arteries that deliver blood to the heart are blocked
- Blood tests: To check for heart failure markers
- Functional status: To see how well you can do everyday activities and physical exertion
- Frailty: To check things like weakness, walking speed and tiredness
- Right heart catheterization: To measure the blood pressure in your heart and lungs
What should you expect before, during and after MCS placement?
Before your MCS device is placed, your care team will educate you about how the device works and what it will be like to live with it. They will work with you to coordinate any tests or appointments you need beforehand.
The placement process varies, depending on the type of MCS device. Your care team will explain what to expect. After your device is placed, your care team will monitor your recovery and your health.
Short-term (temporary) MCS: What happens next?
In an emergency, or during surgery, you may need short-term MCS. Afterward, you may:
- Recover fully and have the MCS device removed
- Transition to long-term support such as an LVAD or TAH
- Be evaluated for a heart transplant
Long-term living with an LVAD or TAH
After you have an LVAD or TAH, you may be able to return to your daily life, with some precautions.
- You’ll need to take several medications. It’s important to take them as directed.
- You and your caregiver will need to care for your equipment, make sure it is powered correctly and take steps to lower your risk of infection.
- You’ll have regular follow-up visits to make sure your MCS device is working like it should and to check for any signs of complications.
- You may want to seek psychological support, since having major surgery and adjusting to the device and the changes in your health may be hard.
- It may be useful for your caregivers to connect with support.
- You may need to prepare to transition to a heart transplant, if that’s an option for you.
FAQs and related resources
What’s the difference between LVAD and TAH?
An LVAD takes over the function of your left ventricle, so it supports your heart. A TAH replaces the heart and takes over its function.
How long can I live with an LVAD?
A lot of factors influence how long you can live with an LVAD, including your overall health and whether the LVAD is used as a bridge to transplant or as destination therapy. Newer technology is helping people live longer. Many people live for two to five years, and some people live longer than that.
Can I shower or swim with an LVAD or TAH?
You can shower with an LVAD or TAH, with precautions. You may be able to bathe or swim, depending on the type of device you have.
Can a temporary device become permanent?
Temporary devices cannot be used permanently. However, they can be replaced with long-term devices like LVAD. Most of the time, a device is used as a bridge to transplant. LVADs may be used permanently in some cases, as destination therapy. Currently, TAHs are only approved as bridge-to-transplant devices.
Learn more about:
Why choose Banner Health for mechanical circulatory support?
When you choose Banner Health for MCS, you get the benefits of:
- One of the most experienced MCS and transplant programs in the Southwest
- Full-spectrum care, from evaluation to surgery to long-term support
- A team-based approach with coordinators that are dedicated only to MCS
- Education and caregiver training customized to you and your loved ones
- Strong outcomes and access to clinical trials
Is MCS right for you?
Whether you need heart support right away or you are looking into your long-term options, we’re here to help.
Find a Banner heart specialist near you.
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