HFSA Expert Consensus Statement on the Medical Management of Patients on Durable Mechanical Circulatory Support

• Published in: Journal of cardiac failure 2023-04, Vol.29 (4), p.479-502
• Main Authors: Trachtenberg, Barry, COWGER, JENNIFER, JENNINGS, DOUGLAS L., GRAFTON, GILLIAN, LOYAGA-RENDON, RENZO, COGSWELL, REBECCA, KLEIN, LIVIU, SHAH, PALAK, KIERNAN, MICHAEL, VOROVICH, ESTHER
• Format: Article
• Language: English
• Subjects: Arrhythmias, Cardiac; Cohort Studies; driveline infection; Heart Failure; Heart-Assist Devices - adverse effects; Humans; left ventricular assist device; Lung; Mechanical circulatory support; pulmonary hypertension; right ventricular failure; vasoplegia
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2023.01.009

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. ACEi, angiotensin-converting enzyme inhibitor; ARNI, angiotensin receptor neprilysin inhibitor; ASA, aspirin; BP, blood pressure; GDMT, guideline-directed medical therapy; GI, gastrointestinal; ICD, implantable cardioverter defibrillator; LVAD, left ventricular assist device; MRA, mineralocorticoid receptor antagonist; OSA, obstructive sleep apnea; PAP, pulmonary artery pressure; RV, right ventricular; RVF, right ventricular failure; SSRI, selective serotonin reuptake inhibitor. [Display omitted]