Unique Patient Populations Requiring Mechanical Circulatory Support

Mechanical circulatory support (MCS) has become increasingly safe and effective, offering solutions to patients who were previously deemed ineligible for either device therapy or cardiac transplantation. Unique patient populations pose challenges to the selection and implantation of MCS devices, and the optimal management of these patients remains a topic of ongoing research. Studies have shown that women have different outcomes and complication rates following MCS, compared with men, and that device selection and implantation techniques must account for differences in anatomy and physiology. Similarly, small adults may face challenges with device sizing and positioning; whereas, morbidly obese patients may require specialized implantation techniques and bariatric surgery, to reduce device-related complications and improve postoperative outcomes. This chapter will focus on the use of MCS in unique patient populations, including women during pregnancy, and in patients with small chest, cardiac cachexia, or frailty, morbid obesity, and adults with congenital heart disease (ACHD), and patients with COVID-19. Device selection and implant techniques are key aspects in these populations. In addition, discussion includes bariatric surgery in patients supported by durable MCS.