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Mechanical Circulatory Support

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Assessment Table 1. Current Recommendations for MCS ACCF/AHA 2009 HF guidelines Consideration of a left ventricular assist device (LVAD) as permanent therapy or DT is reasonable in highly selected patients with refractory end-stage HF and an estimated 1-year mortality >50% with medical therapy. (II-B) HFSA comprehensive HF practice guidelines Patients awaiting heart transplantation who have become refractory to all means of medical circulatory support should be considered for an MCS device as a BTT. (B) Permanent mechanical assistance with an implantable LVAD may be considered in highly selected patients with severe HF refractory to conventional therapy who are not candidates for heart transplantation, particularly those who cannot be weaned from intravenous inotropic support at an experienced HF center. (B) Patients with refractory HF and hemodynamic instability and/or compromised end-organ function with relative contraindications to cardiac transplantation or permanent MCS expected to improve with time or restoration of an improved hemodynamic profile should be considered for urgent MCS as a bridge to decision. These patients should be referred to a center with expertise in the management of patients with advanced HF. (C) Canadian HF guidelines MCS may be offered to selected individuals with end-stage HF who are inotrope dependent and do not meet the traditional criteria for cardiac transplantation. (IIb-B) ESC guidelines 2008/2010 Current indications for LVADs and artificial hearts include bridging to transplantation and managing patients with acute, severe myocarditis. (IIa-C) Although experience is limited, these devices may be considered for long-term use when no definitive procedure is planned. (IIb-C) LVAD may be considered as DT to reduce mortality. (IIa-B)

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