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gastrointestinal system and brain. This can be a very serious problem if the bleeding happens in their brain, lungs, insertion sites of cannulae, or from gastrointestinal system. The patients should be monitored very carefully by frequent physical examinations and lab tests to make sure there is no bleeding. If there is bleeding, then medications can be given to help the blood to stop. Sometimes, surgery is needed to stop the bleeding. Blood and other blood products (such as platelets) may also need to be given if blood counts drop too low. (2) Acute renal failure may sometimes occur due to inadequate blood flow to their kidneys. With dialysis, the kidney damage may get better. However, in some cases, patients may need dialysis for the rest of their life. (3) Systemic or localized infection is another risk for these patients especiall from the insertion site. Infections in these patients can usually be treated with antibiotics. However, some infections can cause to get sick and more organ damages. (4) Leg ischemia is usually the most common problem in these patients due to insertion of the catheter or cannulas through the femoral vessels. In some cases, blood flow may be affected in lower extremity due to occlusion of the vessels and ischemia may occur. Doctors should always be aware of leg ischemia. If this happens, surgery may be needed to get blood flowing back down the leg. (5) Stroke: in patients on short-term p-MCS, stroke is another life-threating complication because of potential small blood clots. This can cause a stroke, and parts of the brain may be permanently damaged.

Percutaneous MCS devices can also cause hemolysis and thrombocytopenia.

are best served by an initial period of stabilization with temporary devices.

30-day mortality [12].

74 Heart Transplantation

Mechanical circulatory support can prevent multi-organ failure and death in patients with advanced heart failure during waiting period. Long-term continuous-flow VAD has played a major role in providing circulatory support during the waiting period prior to transplantation, but long-term LVAD must be inserted through a thoracotomy or sternotomy, which can be hazardous and time consuming. For these reasons, patients in decompensated heart failure

Most series have combined a variety of temporary devices, but few long-term devices, and the evaluations have involved all patients with cardiogenic shock regardless of the indication for and the type of mechanical support and widely varying rates of recovery have been reported. There are four commonly used types of MCS available, which is temporary and percutaneous application. But the device choice and the implantation timing are not definitely established. Data regarding percutaneous MCS devices in cardiogenic shock are limited. A meta-analysis of three randomized trials comparing TandemHeart and Impella to IABP, TandemHeart and Impella were associated with higher cardiac index, higher mean arterial pressure, lower pulmonary capillary wedge pressure, but increased bleeding complications and no difference in

Another trial study showed that the Impella was not associated with decreased 30-day mortality in cardiogenic shock compared to IABP [13]. Each device should be applied according to the patient's condition and time for recovery, bridge-to-long-term devices, or bridge-totransplantation. Another treatment strategy for percutaneous MCS is that we may consider to switch one device with other one depending on the indication. IABP can be opted for first option in patient with cardiogenic shock due to easy availability and rapid insertion. An IABP is simple and safe to insert, but provides little active hemodynamic support and depends on residual left ventricular function to be effective. If patients have worse left ventricular Ahmet Dolapoglu1 \*, Eyup Avci2 and Ahmet Celik3

\*Address all correspondence to: ahmetdolapoglu@yahoo.com

