Muristek
In Reply In his Letter to the Editor about our recent Review, Dr Dalzell makes a case for continued use of temporary percutaneous mechanical circulatory support devices and questions the utility of using 30-day mortality as an end point in trials of these devices. We agree that percutaneous mechanical circulatory support devices are neither a definitive treatment nor a cure for cardiogenic shock. These devices are deployed to temporarily augment systemic perfusion while the etiology of clinical decompensation (in the case of acute myocardial infarction, an occluded epicardial coronary artery) is identified and treated so that the shock state can be reversed. As noted, percutaneous mechanical circulatory support devices can be removed when the acute shock state has resolved and after demonstrating that the heart can maintain adequate systemic perfusion. Alternatively, removal of a percutaneous mechanical circulatory support device should be considered if a patient experiences a device-related complication and the risk of continued use outweighs potential benefit.
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