Treatment
Mechanical Circulatory Support
ÎÎMCS is beneficial in carefully selecteda patients with stage D HFr EF in
whom definitive management (eg, cardiac transplantation) or cardiac
recovery is anticipated or planned. (IIa-B)
ÎÎNondurable MCS, including the use of percutaneous and
extracorporeal ventricular assist devices, is reasonable as a "bridge
to recovery" or a "bridge to decision" for carefully selecteda HFr EF
patients with acute, profound hemodynamic compromise. (IIa-B)
ÎÎDurable MCS is reasonable to prolong survival for carefully selecteda
patients with stage D HFr EF. (IIa-B)
a
Although optimal patient selection for MCS remains an active area of investigation, general
indications for referral for MCS therapy include patients with LVEF <25% and NYHA class III–
IV functional status despite GDMT including, when indicated, CRT, with either high predicted
1- to 2-y mortality (as suggested by markedly reduced peak VO2, clinical prognostic scores, etc) or
dependence on continuous parenteral inotropic support. Patient selection requires a multidisciplinary
team of experienced advanced HF and transplantation cardiologists, cardiothoracic surgeons, nurses,
and, ideally, social workers and palliative care clinicians.
Cardiac Transplantation
ÎÎEvaluation for cardiac transplantation is indicated for carefully
selected patients with stage D HF despite GDMT, device, and surgical
management. (I-C)
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