ISHLT Issues New Guidelines for Care of Mechanical Circulatory Support Device Patients

Published in The Journal of Heart and Lung Transplantation

New York, NY, January 10, 2013 – 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 at www.jhltonline.org.

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.

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 members of their care team before implantation.

Task Force 3 discusses the intra-operative considerations and immediate post-operative care in the intensive care unit (ICU). This section provides recommendations for anesthesia, implantation techniques, explantation techniques, complex anatomic considerations, and early post- operative management in the ICU.

Task Force 4 addresses inpatient management during the post-operative phase, once the patient is out of the ICU and during readmission to the hospital. This section includes recommendations about psychosocial support and suitability for discharge to home and common reasons for hospital readmission and approaches to their management.

Task Force 5 discusses the long-term outpatient care of the MCS patient. The Task Force recommends that after returning home, patients should be managed by a multidisciplinary team that includes cardiovascular surgeons, advanced heart failure cardiologists, and specialized MCS coordinators. It highlights the importance of assessing the patient’s social network and/or caregivers, recommending that the patient and their caregivers should be trained to recognize MCSD alarms and troubleshoot emergencies using both written materials and visual demonstrations and that their emergency response skills should be tested before being discharged from hospital.

“We hope these guidelines provide an impetus for organized dissemination of best practices from various centers with excellent outcomes into the literature to further the field of MCS,” conclude the co-chairs.

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Notes for editors
“The 2013 International Society for Heart and Lung Transplantation Guidelines for Mechanical Circulatory Support: Executive Summary,” The Journal of Heart and Lung Transplantation, Volume 32, Issue 2 (February 2013), published by Elsevier (doi: http://dx.doi.org/10.1016/j.healun.2012.09.01). The online version, including supplementary data, is freely available at www.jhltonline.org.

Full text of the article is available to credentialed journalists upon request. Contact Linda Gruner at jhltmedia@elsevier.com or +1-212-633-3923. To obtain additional information from the ISHLT regarding “The 2013 International Society for Heart and Lung Transplantation Guidelines for Mechanical Circulatory Support” or to arrange an interview with a member of the task force, please contact Amanda W. Rowe, International Society for Heart and Lung Transplantation, at +1-804-873-2541, +1-817-912-1237 (fax), or amanda.rowe@ishlt.org.

Co-chairs: David Feldman, MD, PhD, Minneapolis Heart Institute, Minneapolis, Minnesota, Georgia Institute of Technology and Morehouse School of Medicine; Salpy V Pamboukian, MD, MSPH University of Alabama at Birmingham, Birmingham, Alabama; Jeffrey J. Teuteberg, MD, University of Pittsburgh, Pittsburgh, Pennsylvania.

Task Force Chairs (exclusive of co-chairs): Emma Birks, MD, University of Louisville, Louisville, Kentucky; Katherine Lietz MD Loyola University, Chicago, Maywood, Illinois; Stephanie A. Moore, MD, Massachusetts General Hospital, Boston, Massachusetts; and Jeffrey A. Morgan, MD, Henry Ford Hospital, Detroit, Michigan.

Contributing Writers (exclusive of co-chairs or chairs): Francisco Arabia, MD, Mayo Clinic Arizona, Phoenix, Arizona; Mary E. Bauman, MScN, NP, University of Alberta, Alberta, Canada; Hoger W. Buchholz, MD, University of Alberta, Stollery Children’s Hospital and Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada; Mario Deng, MD, University of California at Los Angeles, California; Marc L. Dickstein, MD, Columbia University, New York, New York; Aly El-Banayosy, MD, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Tonya Elliot, RN, MSN, Inova Fairfax, Falls Church, Virginia; Daniel J. Goldstein, MD, Montefiore Medical Center, New York, New York; Kathleen L. Grady, PhD, APN, Northwestern University, Chicago, Illinois; Kylie Jones, RN, Alfred Hospital, Melbourne, Australia; Katarzyna Hryniewicz, MD, Minneapolis Heart Institute, Minneapolis, Minnesota; Ranjit John, MD, University of Minnesota, Minneapolis, Minnesota; Annemarie Kaan, MCN, RN, St. Paul’s Hospital, Vancouver, British Columbia, Canada; Shimon Kusne, MD, Mayo Clinic Arizona, Phoenix, Arizona; Matthias Loebe, MD, PhD, Methodist Hospital, Houston, Texas; M. Patricia Massicotte, MHSc, MD, University of Alberta, Stollery Children’s Hospital, Edmonton, Alberta, Canada; Nader Moazami, MD, Minneapolis Heart Institute, Minneapolis, Minnesota; Paul Mohacsi, MD, University Hospital, Bern, Switzerland; Martha Mooney, MD, Sentara Norfolk, Virginia Beach, Virginia; Thomas Nelson, MD, ; Mayo Clinic Arizona, Phoenix, Arizona Francis Pagani, MD, University of Michigan, Ann Arbor, Michigan; William Perry, RN, Integris Baptist Health Care, Oklahoma City, Oklahoma; Evgenij V. Potapov, MD, Deutsches Herzzentrum Berlin, Berlin, Germany; J. Eduardo Rame, MD, MPhil, University of Pennsylvania, Philadelphia, Pennsylvania; Stuart D. Russell, MD, Johns Hopkins, Baltimore, Maryland; Erik N. Sorensen. PhD, University of Maryland, Baltimore, Maryland; Benjamin Sun, MD, Minneapolis Heart Institute, Minneapolis, Minnesota; and Martin Strueber, MD, Hannover Medical School, Hanover, Germany.

Independent Reviewers: Abeel A. Mangi, MD, Yale University School of Medicine, New Haven, Connecticut; Michael G. Petty, PhD, RN, of Minnesota Medical Center, Fairview, Minneapolis, Minnesota; and Joseph Rogers, MD, Duke University Medical Center, Durham, North Carolina.

About The Journal Of Heart and Lung Transplantation
A forum that includes all aspects of pre-clinical and clinical science of the failing heart and lung, The Official Publication of the International Society for Heart and Lung Transplantation, The Journal of Heart and Lung Transplantation (www.jhltonline.org) brings readers essential scholarly and timely information in the field of cardiopulmonary transplantation, mechanical and biological support of the failing heart, advanced lung disease (including pulmonary vascular disease), and cell replacement therapy. Importantly, the journal also serves as a medium of communication of pre-clinical sciences in all these rapidly expanding areas.

With an Impact Factor of 4.332, The Journal of Heart and Lung Transplantation (www.jhltonline.org) is ranked 3rd of 24 journals in the Transplantation category, 22nd of 117 journals in the Cardiac and Cardiovascular Systems category, and 6th of 48 journals in the Respiratory System category in the 2011 Journal Citation Reports®, published by Thomson Reuters.

About the International Society for Heart and Lung Transplantation (ISHLT)
The International Society for Heart and Lung Transplantation (www.ishlt.org) is a multidisciplinary, professional organization dedicated to improving the care of patients with advanced heart or lung disease through transplantation, mechanical support, and innovative therapies via research, education, and advocacy. ISHLT was created in 1981 at a small gathering of about 15 cardiologists and cardiac surgeons. Today, ISHLT has over 2500 members from over 45 countries, representing over 14 different disciplines involved in the management and treatment of end-state heart and lung disease. This multinational, multidisciplinary mix is one of the biggest strengths of the Society. It brings greater breadth and depth to ISHLT's educational offerings and provides an exceptional environment for networking and exchanging information on an informal basis.

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Media contact
Linda Gruner
Elsevier
+1-212-633-3923
jhltmedia@elsevier.com