38
Mechanical Circulatory Support
Î MCS is beneficial in carefully selected
a
patients with stage D HFr EF in
whom definitive management (eg, cardiac transplantation) or cardiac
recovery is anticipated or planned. (IIa-B)
Î Nondurable 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 selected
a
HFr EF
patients with acute, profound hemodynamic compromise. (IIa-B)
Î Durable MCS is reasonable to prolong survival for carefully selected
a
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 VO
2
, 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
Î Evaluation for cardiac transplantation is indicated for carefully
selected patients with stage D HF despite GDMT, device, and surgical
management. (I-C)
Treatment
