A Historical Review of Mechanical Circulatory Support

Meaningful and contemporary data regarding the clinical use of mechanical circulatory support (MCS) is founded on the work conducted in the 1950s when a “heart-lung” machine was incorporated to provide support during surgical interventions. Following this milestone, the need to support artificial circulation in patients with heart failure initiated an investigational and legislative collaboration to implement the mission-oriented Artificial Heart Program in the United States during the 1960s. In the subsequent decades, technological discoveries have integrated a series of mechanical systems employed as therapeutic options for short- and long-term artificial circulation in children and adults with advanced heart failure. Since their clinical application, MCS devices have been employed as a bridge to transplantation in over 4000 patients globally. In recent years, the adverse effects and economic burden of MCS have been counterbalanced by the harmonization of therapeutic protocols, the inclusion of multidisciplinary insight, and the allowance of families and patients to participate in shared decision making to address candidacy. In this chapter, we provide a review of the historical aspects of MCS, a therapeutic option for overcoming complexities encountered in reestablishing adequate hemodynamic states and providing a reasonable quality of life

The Role of Surgical Resection and Liver Transplantation for the Treatment of Intrahepatic Cholangiocarcinoma

Intrahepatic cholangiocarcinoma (iCCA) is a rare and complex malignancy of the biliary epithelium. Due to its silent presentation, patients are frequently diagnosed late in their disease course, resulting in poor overall survival. Advances in molecular profiling and targeted therapies have improved medical management, but long-term survival is rarely seen with medical therapy alone. Surgical resection offers a survival advantage, but negative oncologic margins are difficult to achieve, recurrence rates are high, and the need for adequate future liver remnant limits the extent of resection. Advances in neoadjuvant and adjuvant treatments have broadened patient treatment options, and these agents are undergoing active investigation, especially in the setting of advanced, initially unresectable disease. For those who are not able to undergo resection, liver transplantation is emerging as a potential curative therapy in certain cases. Patient selection, favorable tumor biology, and a protocolized, multidisciplinary approach are ultimately necessary for best patient outcomes. This review will discuss the current surgical management of locally advanced, liver-limited intrahepatic cholangiocarcinoma as well as the role of liver transplantation for select patients with background liver disease