TY - JOUR
T1 - HFSA Expert Consensus Statement on the Medical Management of Patients on Durable Mechanical Circulatory Support
AU - Trachtenberg, Barry
AU - COWGER, JENNIFER
AU - JENNINGS, DOUGLAS L.
AU - GRAFTON, GILLIAN
AU - LOYAGA-RENDON, RENZO
AU - COGSWELL, REBECCA
AU - KLEIN, LIVIU
AU - SHAH, PALAK
AU - KIERNAN, MICHAEL
AU - VOROVICH, ESTHER
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/4
Y1 - 2023/4
N2 - The medical management of patients supported with durable continuous flow left ventricular assist device (LVAD) support encompasses pharmacological therapies administered in the preoperative, intraoperative, postoperative, and chronic LVAD support stages. As patients live longer on LVAD support, the risks of LVAD-related complications and progression of cardiovascular and other diseases increase. Using existing data from cohort studies, registries, randomized trials, and expert opinion, this Heart Failure Society of America Consensus Document on the Medical Management of Patients on Durable Mechanical Circulatory Support offers best practices on the management of patients on durable mechanical circulatory support, focusing on pharmacological therapies administered to patients on continuous flow LVADs. Although quality data in the LVAD population are few, the use of guideline-directed heart failure medical therapies and the importance of blood pressure management, right ventricular preload and afterload optimization, and antiplatelet and anticoagulation regimens are discussed. Recommended pharmacological regimens used to mitigate or treat common complications encountered during LVAD support, including arrhythmias, vasoplegia, mucocutaneous bleeding, and infectious complications, are addressed. Finally, this document touches on important potential pharmacological interactions from antidepressants and herbal and nutritional supplements of relevance to providers of patients on LVAD support.
AB - The medical management of patients supported with durable continuous flow left ventricular assist device (LVAD) support encompasses pharmacological therapies administered in the preoperative, intraoperative, postoperative, and chronic LVAD support stages. As patients live longer on LVAD support, the risks of LVAD-related complications and progression of cardiovascular and other diseases increase. Using existing data from cohort studies, registries, randomized trials, and expert opinion, this Heart Failure Society of America Consensus Document on the Medical Management of Patients on Durable Mechanical Circulatory Support offers best practices on the management of patients on durable mechanical circulatory support, focusing on pharmacological therapies administered to patients on continuous flow LVADs. Although quality data in the LVAD population are few, the use of guideline-directed heart failure medical therapies and the importance of blood pressure management, right ventricular preload and afterload optimization, and antiplatelet and anticoagulation regimens are discussed. Recommended pharmacological regimens used to mitigate or treat common complications encountered during LVAD support, including arrhythmias, vasoplegia, mucocutaneous bleeding, and infectious complications, are addressed. Finally, this document touches on important potential pharmacological interactions from antidepressants and herbal and nutritional supplements of relevance to providers of patients on LVAD support.
KW - Mechanical circulatory support
KW - driveline infection
KW - left ventricular assist device
KW - pulmonary hypertension
KW - right ventricular failure
KW - vasoplegia
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UR - http://www.scopus.com/inward/citedby.url?scp=85150849260&partnerID=8YFLogxK
U2 - 10.1016/j.cardfail.2023.01.009
DO - 10.1016/j.cardfail.2023.01.009
M3 - Review article
C2 - 36828256
AN - SCOPUS:85150849260
SN - 1071-9164
VL - 29
SP - 475
EP - 498
JO - Journal of cardiac failure
JF - Journal of cardiac failure
IS - 4
ER -
