Patients will be considered for destination mechanical circulatory support device (
MCSD) implantation when all other organ-saving treatment options have failed and they are not eligible for
heart transplantation. Current medical evidence suggests that only for those patients who are inotrope-dependent and therefore likely have a 1-year survival probability without
MCSD implantation of less than 50%,
MCSD intervention will add to survival and quality-of-life benefit. Suitable candidates for
MCSD are those patients who have a high risk of dying from
heart failure but acceptable noncardiac risk. Evaluation of patients for
MCSD requires a systematic and critical review of all organ systems and of the psychosocial situation. Specifically, right ventricular function and risk of right ventricular failure should be evaluated before planning destination
MCSD implantation. Treatment will focus on prompt recovery from
MCSD implantation, maintaining optimal treatment for
heart failure, and preventing/treating
MCSD complications, including
infection,
bleeding, coagulopathy, right
heart failure, and device dysfunction.
MCSD programs should be organized as an advanced
heart failure center directed by specialized
heart failure cardiologists, surgeons expert at implant and management of
MCSD, specialized nurses, social workers, psychologists, financial experts, and physical therapists.
MCSD practice is based on a patient-centered theory, with an appropriate understanding of the respective roles of the physician and the patient during their iterative encounters in which the patient is an autonomous person making responsible personal health decisions while the health care team is providing continued expert and empathic counseling about various options, based on systematic outcomes research (eg, by participation in the Interagency Registry for Mechanically Assisted Circulatory Support -
MCSD database ).