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MCS Candidate Selection Criteria

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Mechanical Circulatory Support in End-Stage Heart Failure

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Abstract

Nowadays, approximately every patient affected from end-stage acute or chronic heart failure may be a potential candidate for MCS; therefore, a careful patient selection for MCS is crucial to establish an effective MCS program, having an impact on both the number of patient treated and the outcomes and the costs of the entire program.

Since MCS is a relatively young and still rapidly developing field, indications and institutional policies have been frequently modified over the past 30 years based on new available technologies or newly found clinical evidences. Nevertheless, due to the high individual variability of the clinical presentation of end stage heart failure it is nearly impossible to produce generally accepted patient selection criteria which guarantee best treatment for each individual patient.

For the last decade a clear paradigm shift has been made in the application of durable VADs in patients with acute, severe hemodynamic deterioration. Due to their higher risk for morbidity and mortality, longer ICU stay, higher incidence of debilitating complications, and significantly increased costs, the application of Temporary Circulatory Support (TCS) systems with lower costs and less invasiveness (percutaneous VAD) has been the first-line choice for those patients in their worst clinical conditions. Durable VADs proof best clinical results with hemodynamic stable end-stage heart failure patients.

The INTERMACS classification, introduced in the 90s, tried to classify the acuity and severity of end-stage heart failure patients based on their expected one year survival. This was one first attempt to introduce a standardization of the terminology for end-stage heart failure patients in order to scientifically compare the results and outcome of this expanding patient population when they were implanted a durable VAD.

Further selection criteria for MCS implantation to be considered:

  • Cost/benefit analysis

  • Device strategy (BTD, BTT, BTC, DT)

  • Underlying disease/etiology and eventual reversibility

  • Patient comorbidities and their reversibility

  • Frailty, nutritional status, and risk of infections

  • Assessment of hemorrhagic and thromboembolic risk

Once the decision of an MCS implantation has been considered as a valuable option, the following criteria should be further investigated:

  • Available risk scores

  • Right Heart Dysfunction Reversibility and/or need of preoperative management of right ventricle to reduce perioperative unplanned RVAD implantation

  • Management of the aortic valve to avoid approach of the aortic valve during mid-/long-term follow-up

  • Surgical management and/or need of eventual concomitant procedures

  • Need of pulsatility and eventual strategies to prevent hemorrhagic complications

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Authors and Affiliations

  1. Monaldi Hospital, Az. dei Colli, Naples, Italy

    Cristiano Amarelli & Ciro Maiello

  2. AZ Sint Jan, Brugge, Belgium

    Marianna Buonocore

  3. San Camillo Hospital, Rome, Italy

    Andrea Montalto

  4. University of California San Francisco, San Francisco, CA, USA

    Georg Wieselthaler

Authors
  1. Cristiano Amarelli
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  2. Marianna Buonocore
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  3. Ciro Maiello
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  4. Andrea Montalto
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  5. Georg Wieselthaler
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Corresponding authors

Correspondence to Cristiano Amarelli or Georg Wieselthaler .

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Editors and Affiliations

  1. San Camillo-Forlanini Hospital, Rome, Italy

    Andrea Montalto

  2. Cardiac Surgery, S.Orsola-Malpighi Hospital, Bologna, Italy

    Antonio Loforte

  3. San Camillo-Forlanini Hospital, Rome, Italy

    Francesco Musumeci

  4. Deutsches Herzzentrum Berlin, Berlin, Germany

    Thomas Krabatsch

  5. Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky, USA

    Mark S. Slaughter

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Amarelli, C., Buonocore, M., Maiello, C., Montalto, A., Wieselthaler, G. (2017). MCS Candidate Selection Criteria. In: Montalto, A., Loforte, A., Musumeci, F., Krabatsch, T., Slaughter, M. (eds) Mechanical Circulatory Support in End-Stage Heart Failure. Springer, Cham. https://doi.org/10.1007/978-3-319-43383-7_4

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