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Eur J Cardiothorac Surg. 2019 May 17. pii: ezz098. doi: 10.1093/ejcts/ezz098. [Epub ahead of print]

2019 EACTS Expert Consensus on long-term mechanical circulatory support.

Author information

1
Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany.
2
Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
3
Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, UDC, La Coruña, Spain.
4
Sorbonne Université, INSERM, Institute of Cardiometabolism and Nutrition, Paris, France.
5
Service de médecine intensive-réanimation, Institut de Cardiologie, APHP, Hôpital Pitié-Salpêtrière, Paris, France.
6
Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany.
7
Department of Medical Microbiology, University College of Dublin, Dublin, Ireland.
8
Department of Anaesthesiology, German Heart Center Berlin, Berlin, Germany.
9
Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands.
10
Department of Cardiothoracic, S. Orsola Hospital, Transplantation and Vascular Surgery, University of Bologna, Bologna, Italy.
11
Department of Medicine Karolinska Institute, Heart and Vascular Theme, Karolinska University Hospital, Solna, Sweden.
12
Department of Cardiovascular Surgery Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland.
13
Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany.
14
Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.
15
Department of Cardiovascular Surgery, Ege University, Izmir, Turkey.
16
Advanced Heart Failure and Mechanical Circulatory Support Program, Cardiac Intensive Care, San Raffaele Hospital, Vita Salute University, Milan, Italy.
17
Department of Anesthesia and Intensive Care, San Raffaele Hospital, Vita Salute University, Milan, Italy.
18
Department of Congenital Pediatric Surgery, Zurich Children's Hospital, Zurich, Switzerland.
19
Royal Papworth Hospital, Cambridge, United Kingdom.
20
Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
21
Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.

Abstract

Long-term mechanical circulatory support (LT-MCS) is an important treatment modality for patients with severe heart failure. Different devices are available, and many-sometimes contradictory-observations regarding patient selection, surgical techniques, perioperative management and follow-up have been published. With the growing expertise in this field, the European Association for Cardio-Thoracic Surgery (EACTS) recognized a need for a structured multidisciplinary consensus about the approach to patients with LT-MCS. However, the evidence published so far is insufficient to allow for generation of meaningful guidelines complying with EACTS requirements. Instead, the EACTS presents an expert opinion in the LT-MCS field. This expert opinion addresses patient evaluation and preoperative optimization as well as management of cardiac and non-cardiac comorbidities. Further, extensive operative implantation techniques are summarized and evaluated by leading experts, depending on both patient characteristics and device selection. The faculty recognized that postoperative management is multidisciplinary and includes aspects of intensive care unit stay, rehabilitation, ambulatory care, myocardial recovery and end-of-life care and mirrored this fact in this paper. Additionally, the opinions of experts on diagnosis and management of adverse events including bleeding, cerebrovascular accidents and device malfunction are presented. In this expert consensus, the evidence for the complete management from patient selection to end-of-life care is carefully reviewed with the aim of guiding clinicians in optimizing management of patients considered for or supported by an LT-MCS device.

KEYWORDS:

Expert consensus; Heart failure; Left ventricular assist devices; Mechanical circulatory support

PMID:
31100109
DOI:
10.1093/ejcts/ezz098

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