Advanced heart failure care
Mechanical
Circulatory Support
Mechanical circulatory support helps maintain blood flow when the heart cannot pump enough on its own. Support may be temporary during critical illness or durable for selected people with advanced heart failure.
Support matched to need
From hours to years
The Heart Team chooses a strategy according to the clinical situation, the expected duration of support and the patient’s goals. Device-specific decisions require specialist evaluation.
Temporary support
Short-term systems can stabilize circulation during cardiogenic shock, after cardiac surgery or while the team evaluates recovery and next steps.
- Intra-aortic balloon pump
- Percutaneous ventricular assist pump
- Extracorporeal membrane oxygenation (VA-ECMO)
Durable support
A surgically implanted ventricular assist device can support the circulation for longer periods. The most common durable system supports the left ventricle (LVAD).
- Bridge to transplantation
- Bridge to candidacy or decision
- Long-term therapy when transplant is not planned
An LVAD assists the heart; it does not remove or replace the whole heart. A total artificial heart is a different and less common form of support.
Why support is used
Time can serve different goals
The same device may serve a different purpose for each person. Goals can evolve as the heart, other organs and overall condition change.
Bridge to recovery
Support gives the heart and other organs time to recover when improvement may be possible.
Bridge to decision
Support stabilizes circulation while the team clarifies prognosis, treatment options and patient preferences.
Bridge to transplant
A durable LVAD may maintain circulation while an eligible person waits for a suitable donor heart.
Long-term therapy
For selected patients who are not pursuing transplant, durable support may improve survival and daily function.
A multidisciplinary pathway
The durable-support journey
Evaluation considers the whole person—not only the strength of the heart. The program prepares both the patient and a reliable support network for life with the device.
Referral
Advanced heart failure is reviewed despite optimized medical and device therapy.
Evaluation
Heart, right ventricle, kidneys, liver, nutrition, infection risk, frailty and anatomy are assessed.
Shared decision
The team discusses expected benefits, burdens, alternatives, values and future goals of care.
Implantation
The pump is implanted surgically and connected to an external controller and power source.
Recovery
ICU care, rehabilitation, medication adjustment and training build confidence before discharge.
Home & follow-up
Daily equipment checks, driveline care, medicines and regular VAD-center visits continue.
Heart-failure cardiology · cardiac surgery · VAD coordinators · intensive care · nursing · rehabilitation · pharmacy · nutrition · social work · palliative care · patient and caregivers
Living with durable support
Preparedness creates independence
Many people return to meaningful activity with an LVAD. Confidence comes from repeated training, reliable routines and immediate access to the VAD team.
A partnership for daily life
The equipment bag may be discreet, but safe living requires constant power, backup supplies and a practiced emergency plan. The patient’s own device manual and program instructions always take priority.
Never silence, disconnect or troubleshoot an unfamiliar alarm by guessing.
Carry charged batteries and the required backup controller or supplies. Know the approved power-change sequence.
Use the center’s sterile dressing and stabilization method. Report redness, pain, drainage or fever promptly.
Take anticoagulation and all other medicines exactly as prescribed. Attend scheduled blood tests and reviews.
Do not submerge equipment. Follow program-specific showering and imaging instructions; never assume MRI compatibility.
Plan power, supplies, emergency contacts and the nearest VAD-capable center before leaving home.
Keep the VAD emergency card accessible. Caregivers should rehearse the program’s alarm and power-loss plan.
Shared decision-making
Questions worth asking
What is the goal of support in my situation?
What benefits and complications are most relevant to me?
Who will be trained as my caregiver or backup person?
What will daily equipment and driveline care require?
What should we do for each alarm or loss of power?
How could support affect transplant eligibility and future goals?
Common questions
Mechanical support FAQ
Does an LVAD replace the heart?+
No. An LVAD assists the heart’s pumping function. The native heart remains in place.
Can a person with an LVAD have no palpable pulse?+
With a continuous-flow device, the pulse may be weak or difficult to feel. Blood-pressure and emergency assessment should follow the patient’s VAD-program training.
Can an LVAD be used while waiting for transplant?+
Yes. It may be used as a bridge to transplant. It may also support a person while candidacy is clarified or provide long-term therapy when transplant is not planned.
Can I shower or swim with an LVAD?+
Do not swim or submerge the equipment. Showering is only performed using the timing, protective equipment and method approved by the patient’s VAD program.
Can I travel with an LVAD?+
Many people travel after recovery, but power, backup equipment, supplies, contacts and access to a VAD-capable center must be planned in advance with the team.
What should I do when an alarm occurs?+
Follow the written device-specific alarm plan and contact the VAD team. Call emergency services for severe symptoms, loss of power that cannot be corrected as trained, or loss of consciousness.
Contemporary MCS care
This patient pathway reflects the 2023 ISHLT Mechanical Circulatory Support Guideline: multidisciplinary selection, pre-implant preparation, perioperative management, longitudinal care, complication prevention and shared decision-making.