Usage of percutaneous left ventricular assist devices in clinical practice and high-risk percutaneous coronary intervention

Patients who require coronary revascularization and present with poor left ventricular function and complex coronary anatomy are at high risk for percutaneous coronary intervention (PCI) and coronary artery bypass grafting surgery. Some of these patients are poor surgical candidates because of previous cardiac surgery or significant comorbidities. The recent approval and availability of percutaneous left ventricular assist devices has created an opportunity for the highest risk patients. This article reviews currently available mechanical circulatory support systems and portable extracorporeal oxygenation, describing hemodynamic and physiologic rationales, indications, strategies, and available evidence for their use in high risk PCI.