As mechanical circulatory support (MCS) devices become more durable, safe and reliable, their use by cardiologists and other heart failure (HF) specialists has grown. To help physicians appropriately apply these devices in practice, the American Heart Association (AHA) has published an inaugural set of guidelines.
MCS devices play a key role in survival for patients with advanced heart failure, wrote Jennifer L. Peura, MD, of the Medical University of South Carolina in Charleston and chair of the AHA’s HF and transplantation committee. These technologies have evolved over the past several decades into effective therapies, either as bridges to transplantation or recovery, or as a destination therapy.
“As the MCS field evolves, practitioners caring for advanced HF patients will require an understanding of the appropriate application of MCS, ”Peura and colleagues wrote. “In addition, an increasing number of community programs seek to provide alternative therapy for HF. As MCS use and management move beyond the purview of academic transplant centers, it is essential that the indications for MCS and the essentials of device management are broadly understood.”
The authors detailed the types of devices available, how they work, the scientific evidence on their efficacy and complications and clinical considerations. They explained that some technologies that initially were designed as bridge to transplantation options have undergone iterations that allow clinical uses such as stabilizing patients before transfer to specialized HF facilities. The success of bridge-to-transplantation and bridge-to-recovery therapies also helped pave the way for destination therapies.
Peura et al reviewed considerations such as identifying high-risk patients, patient selection, evaluating risk in these patients and complicating conditions such as structural heart disease, hepatic and kidney dysfunctions and other factors. They offered a summary of regulatory issues and concluded with recommendations for the use of MCS.
The scientific statement was published online Oct. 29 in Circulation. The list of recommendation is available here.