2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care (Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention)

Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella(®); left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock, and acute decompensated heart failure. Specialized uses for right-sided support and in pediatric populations are discussed and the clinical utility of mechanical circulatory support devices is reviewed, as are the American College of Cardiology/American Heart Association clinical practice guidelines.

Optical Fibre Pressure Sensors in Medical Applications

This article is focused on reviewing the current state-of-the-art of optical fibre pressure sensors for medical applications. Optical fibres have inherent advantages due to their small size, immunity to electromagnetic interferences and their suitability for remote monitoring and multiplexing. The small dimensions of optical fibre-based pressure sensors, together with being lightweight and flexible, mean that they are minimally invasive for many medical applications and, thus, particularly suited to in vivo measurement. This means that the sensor can be placed directly inside a patient, e.g., for urodynamic and cardiovascular assessment. This paper presents an overview of the recent developments in optical fibre-based pressure measurements with particular reference to these application areas.

Future Directions for Percutaneous Mechanical Circulatory Support Devices

Outcomes of patients in cardiogenic shock remain high, but the development of novel percutaneous mechanical circulatory support devices offers additional therapeutic options. Hand in hand with innovations in device technology, however, must also come development of integrated circulatory support networks focusing on rapid assessment of patients, multidisciplinary discussion, and timely therapeutic intervention. This article summarizes some of the recent developments in device technology; potential procedures for patient risk stratification, device selection, and response to therapy; management of vascular access to reduce insertion point complications; and some of the expanding potential roles of percutaneous mechanical circulatory support devices.