The tightrope walk between temporary and permanent mechanical circulatory support
In recent years, tremendous progress has been made in treatment and management of chronic heart failure, with novel drugs and devices contributing to reduced mortality and improved quality of life. In contrast, acute heart failure and cardiogenic shock have seen no such advancement in therapy and lack large positive outcome trials (1,2). Concomitantly, there is a strong rise in the use of temporary mechanical circulatory support (MCS) for cardiogenic shock (3,4), and some centers also implant permanent left ventricular assist devices (LVAD) at INTERMACS stages 1 to 3 (5). Yet, evidence from randomized controlled trials for temporary or permanent MCS remains limited, not at least because controlled MCS studies in acute heart failure and cardiogenic shock are admittedly difficult to conduct and to interpret. Therefore, MCS decision making in acute cardiac conditions is still largely based on experience and sometimes empiricism, and bridging and weaning strategies vary between centers. In this context, we read with great interest the report of Osswald and colleagues (6).