New statement outlines recommendations for use of mechanical circulatory support

Issue: December 2012

The American Heart Association recently published a scientific statement with recommendations for the use of mechanical circulatory support.

The new recommendations address issues related to management strategies for mechanical circulatory support, patient selection criteria, indications for use, clinical perspectives and complicating conditions, among other topics.

Specific recommendations include:

Mechanical circulatory support is recommended as a bridge-to-transplant for patients with end-stage HF eligible for transplant who are failing optimal therapies and are at heightened risk for mortality before receiving a heart transplantation.
Early referral of patients with advanced is reasonable because data show that mechanical circulatory support implanted before the development of advanced HF is associated with better outcomes.
Durable long-term mechanical circulatory support should be considered as a bridge-to-potential-transplant for patients ineligible for heart transplantation because of pulmonary hypertension related to HF alone.
Long-term mechanical circulatory support is not recommended in patients with advanced kidney disease in whom renal function is unlikely to recover and who are at high risk for progression to renal replacement therapy.
Nutritional status assessment should be part of the evaluation for patient selection for durable long-term mechanical circulatory support.
Mechanical circulatory support can be considered for obese patients.
Psychosocial, behavioral and environmental factor assessment is recommended as part of the evaluation for patient selection for durable, long-term mechanical circulatory support.
Evaluation of potential candidates for a multidisciplinary team is recommended for selection of patients for mechanical circulatory support.

“Many exciting changes in the field of mechanical circulatory support have occurred in the past few years, including the development of smaller portable pumps and the concept of DT, or permanent pump placement as an alternative to heart transplantation.

“Currently, there are no published guidelines for the use of mechanical circulatory support. Thus, it is our intent that this statement will provide the contemporary cardiologist and other HF providers with an understanding of general considerations when determining the appropriateness of mechanical circulatory support,” writing committee chair Jennifer L. Peura, MD, of the Medical University of South Carolina, and colleagues wrote in the statement.

For more information:

Peura JL. Circulation. 2012;doi:10.1161/CIR.0b013e3182769a54.

Disclosure: Peura reports no relevant financial disclosures.