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Mechanical Support in Acute Perioperative Heart Failure: Are Assist Devices Smart Enough to Heal the Heart?

Perioperative heart failure has many appearances. In this review, any attempt to achieve revascularization or repair by thrombolysis, percutaneous transluminal coronary angioplasty (PTCA), or open-heart surgery is considered an operation. Acute heart failure may be caused by pump dysfunction on the basis of myocardial infarction, valve failure, or a combination of these two. From the point of view of the effectiveness of mechanical support, questions arise about timing, the impact on recovery, and the intended duration of the support. However, one may also question the mode of mechanical support with respect to pulsatility, recovery, permanency, or bridge to transplant. Also, the previous conception that intra-aortic balloon pump (IABP) support is just a temporary support mode is overtaken by new technical developments that enable long-duration ambulatory users.1,2 The main challenge for the treatment of acute heart failure with mechanical support devices remains an appropriate estimation of the potential for recovery of the patient's heart and the recovery from potential multi-organ failure. The availability of devices will extend the indication for perioperative support, but also highlights questions about the postoperative support strategy. Sensible use of mechanical support depends on the predictability of the device's performance and the resources available. This perspective raises questions about whether assist devices, and their users, are smart enough.