AHA Mechanical Circulatory Support GUIDELINES App brought to you courtesy of Guideline Central. Enjoy!
Issue link: https://eguideline.guidelinecentral.com/i/120008
Recommendations for MCS ����MCS 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) ����Implantation 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) ����MCS 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) ����Elective 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) ����Patients 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) ��Careful assessment of RV function is recommended as part of the evaluation �� 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) ����Assessment of nutritional status is recommended as part of the evaluation for patient selection for durable, long-term MCS. (I-B) ����Patients with obesity (BMI ���30 to ���40 kg/m2) derive benefit from MCS and may be considered for longterm MCS. (IIb-B) ����Assessment of psychosocial, behavioral, and environmental factors is beneficial as part of the evaluation for patient selection for durable, longterm MCS. (I-C) ����Evaluation of potential candidates by a multidisciplinary team is recommended for the selection of patients for MCS. (I-C)