New MCDS guidelines address common issues

MECHANICAL circulatory support (MCS) is a rapidly growing technology used to treat advanced heart failure. Thousands of patients worldwide have now undergone implantation of long- term MCS devices (MCSDs) that can enable them to return home and resume a normal lifestyle. The International Society for Heart and Lung Transplantation (ISHLT) convened an international panel of experts in all aspects of MCS care, which has developed practice guidelines to provide a common framework for the care and treatment of MCS patients. The Executive Summary of these guidelines is published in the February issue of The Journal of Heart and Lung Transplantation and is freely available online.

Chaired by David Feldman, MD, PhD, Minneapolis Heart Institute, and the Georgia Institute of Technology and Morehouse School of Medicine; Salpy V Pamboukian, MD, MSPH, University of Alabama at Birmingham; and Jeffrey J. Teuteberg, MD, University of Pittsburgh, the guidelines were developed by consensus by a team of 38 writers and reviewers including cardiologists, cardiac surgeons, MCS coordinators, and other members of the global multidisciplinary team.

“Because MCS is an evolving field, device availability varies from center to center. We therefore aim to address general issues of long-term use and not to focus on nuances of individual devices,” explain the co-chairs.

“Short-term success with MCS therapy largely depends on patient selection, surgical technique, and post-operative management. Long-term success depends on physician and patient engagement in excellent care of their device and personal health,” they say.

Addressing common issues

The document results from the work of five Task Forces:

Task Force 1 addresses the important issue of patient selection and risk management prior to permanent pump implantation. It makes recommendations about how candidates for MCSD implantation should be evaluated and classified beforehand, including clinical assessment of heart failure etiology and anatomic considerations, as well as specific recommendations for candidates with existing disease such as diabetes, cancer, tobacco use, and obesity. Medical and psychosocial evaluation, assessment of operative risk, and ethical dilemmas are also discussed.

Task Force 2 discusses the mechanisms that are important for patient optimization before device implantation and makes recommendations for multidisciplinary care, education, and psychosocial support. This section covers the management of cardiac and non-cardiac risk factors, optimizing patients with relative contraindications, and informed consent and ethical issues as a continuum from Task Force 1. MCS patients once consented are membersNike Womens Shoes