Recommendations for MCS
ÎÎMCS for BTT indication should be considered for transplant-eligible
patients with end-stage HF who are failing optimal medical, surgical, and/
or device therapies and are at high risk of dying before receiving a heart
transplant. (I-B)
ÎÎImplantation of MCS in patients before the development of advanced
HF (ie, hyponatremia, hypotension, renal dysfunction, and recurrent
hospitalizations) is associated with better outcomes. Therefore, early
referral of advanced HF patients is reasonable. (IIa-B)
ÎÎMCS with a durable, implantable device for permanent therapy or DT is
beneficial for patients with advanced HF, high 1-year mortality resulting
from HF, and the absence of other life-limiting organ dysfunction who are
failing medical, surgical, and/or device therapies and who are ineligible
for heart transplantation. (I-B)
ÎÎElective rather than urgent implantation of DT can be beneficial when
performed after optimization of medical therapy in advanced HF patients who
are failing medical, surgical, and/or device therapies. (IIa-C)
• Urgent nondurable MCS is reasonable in hemodynamically compromised HF patients
with end-organ dysfunction and/or relative contraindications to heart transplantation/
durable MCS who are expected to improve with time and restoration of an improved
hemodynamic profile. (IIa-C)
• These patients should be referred to a center with expertise in the management of
durable MCS and patients with advanced HF. (I-C)
ÎÎPatients who are ineligible for heart transplantation because of pulmonary
hypertension related to HF alone should be considered for bridge to
potential transplant eligibility with durable, long-term MCS. (IIa-B)
ÎCareful assessment of RV function is recommended as part of the evaluation
Î
for patient selection for durable, long-term MCS. (I-C)
• Long-term MCS is not recommended in patients with advanced kidney disease in whom
renal function is unlikely to recover despite improved hemodynamics and who are therefore
at high risk for progression to renal replacement therapy. (III-C)
• Long-term MCS as a bridge to heart-kidney transplantation might be considered on
the basis of availability of outpatient hemodialysis. (IIb-C)
ÎÎAssessment of nutritional status is recommended as part of the evaluation
for patient selection for durable, long-term MCS. (I-B)
ÎÎPatients with obesity (BMI ≥30 to ≥40 kg/m2) derive benefit from MCS and
may be considered for longterm MCS. (IIb-B)
ÎÎAssessment of psychosocial, behavioral, and environmental factors is
beneficial as part of the evaluation for patient selection for durable, longterm MCS. (I-C)
ÎÎEvaluation of potential candidates by a multidisciplinary team is
recommended for the selection of patients for MCS. (I-C)
