ABSTRACT
The development of the extracorporeal heart-lung machine, or cardiopulmonary bypass (CPB) circuit as it is sometimes called, made possible heart surgery as we know it today. Even with this technology, however, not all patients with cardiac disorders are suitable candidates for coronary bypass operations or valve replacement surgery due to the magnitude of the underlying disease. Fortunately, other technological advances have occurred so that devices are now available to support even the most profound circulatory failure. These include the intra-aortic balloon pump (IABP) for acute management of cardiac failure and the left ventricular assist device (LVAD) for chronic end-stage LV failure. While such devices are generally employed to salvage whatever cardiac function exists in anticipation for future cardiac transplantation, more recent technological approaches have aimed at the management of the failing heart from the standpoint of maintaining additional years of meaningful life even when transplantation is not a suitable alternative. This chapter reviews the technological strategies currently available to support the failing circulation and which patients are likely to benefit most from these approaches.
