Daniel Burkhoff, Gabriel Sayer, Darshan Doshi, Nir Uriel
An increasing number of devices can provide mechanical circulatory support (MCS) to patients with acute hemodynamic compromise and chronic end-stage heart failure. These devices work by different pumping mechanisms, have various ﬂow capacities,are inserted by different techniques,and have different sites from which blood is with drawn and returned to the body. These factors result in different primary hemodynamic effects and secondary responses of the body. However, these are not generally taken into account when choosing a device for a particular patient or while managing a patient undergoing MCS. In this review, we discuss fundamental principles of cardiac, vascular, and pump mechanics and illustrate how they provide a broad foundation for understanding the complex interactions between the heart, vasculature, and device, and how they may help guide future research to improve patient outcomes. (J Am Coll Cardiol 2015;66:2663–74) © 2015 by the American College of Cardiology Foundation.