European Heart Journal Supplements: Prof. Christophe Vandenbriele Discusses the Role of Temporary Mechanical Circulatory Support (tMCS) in Heart Failure

Key Takeaways: 

• Timely Intervention is Crucial: Success in treating acute heart failure and cardiogenic shock depends on early use of temporary mechanical circulatory support (tMCS).
• Guiding Treatment Decisions: Key questions—such as assessing biventricular failure, oxygen needs, and right ventricular function—guide effective treatment decisions.
• Role of tMCS: tMCS helps unload the heart and guide blood flow in alignment with normal physiology, making it a critical tool in advanced heart failure care.

Professor Christophe Vandenbriele, MD, discusses key aspects of his paper “The role of temporary mechanical circulatory support in acute on chronic heart failure” published in the 2025 European Heart Journal supplement titled “Mechanical Circulatory Support in Special Settings: the Heart Team Approach.” Prof. Vandenbriele is a cardiologist and cardiac intensivist at Cardiovascular Center Aalst in Belgium and Royal Brompton and Harefield Hospital in London, UK.

Prof. Vandenbriele explains that heart failure is a spectrum from acute heart failure to cardiogenic shock. He highlights four European Society of Cardiology (ESC) heart failure categories: acute decompensated heart failure, acute pulmonary edema, isolated right ventricular failure, and cardiogenic shock. His paper focuses on acute heart failure and cardiogenic shock.

“The most important thing in acute management of heart failure and cardiogenic shock is time,” Prof. Vandenbriele emphasizes. “Because you can dive in with the most fancy device, but if you’re too late, you’re too late. So timing is everything.” He also provides three questions he asks when managing patients with heart failure: (1) Is it biventricular failure? (2) Does the patient need additional oxygen or removal of carbon dioxide? (3) How is the right ventricle doing? He then highlights the importance of unloading with temporary mechanical circulatory support (tMCS) to guide blood in the same direction as normal physiology.

Prof. Vandenbriele discusses the significance of the heart team in management of acute heart failure and cardiogenic shock. He explains that this multidisciplinary team (MDT) decides which institutions will treat patients, what types of treatment will be initiated, and what the escalation therapy will be if conventional therapy is not enough. “The multidiscipinary team,” he states, “plays a central role in controlling and pooling the critical knowledge.” He also emphasizes that good teamwork between hub and spoke hospitals is key to success. He highlights that as experience with tMCS increases, its role is expanding to treat patients previously deemed impossible to treat.

In his concluding remarks, Prof. Vandenbriele states, “The most important factor that we should keep in mind is time. We should dive in with our devices as soon as possible. And here the highly specialized MDT plays a crucial role to make the path and the pathway that the patient will follow. Temporary mechanical circulatory support is gaining a lot of interest in this treatment and here again, the specialized MDT and the hub and spoke model is crucial and central in guiding our management.”