How Mechanical Circulatory Support Treatment is Regulated

Mechanical Circulatory Support (MCS) has become an increasingly favoured treatment-option for people who experience advanced heart-disease, in recent years. In order to ensure it is administered as carefully as possible, The International Society for Heart and Lung Transplantation, or ISHLT, has recently developed practice guidelines, drawn up by a panel of highly-respected international experts.

The guidelines were developed by a team of 38 researchers and health-professionals, including cardiologists, cardiac surgeons and other members of the international-team.

“Because MCS is an evolving field, device availability varies from centre to centre. We therefore aim to address general issues of long-term use and not to focus on nuances of individual devices,” assert the panel. “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”. This document has led to the setting up of five work-forces, which each deal with specific aspects of the treatment.

Task Force 1 examines issues relating to patient selection and how MCS implantation should be evaluated and classified prior to treatment, as well as specific recommendations for patients with existing diseases such as diabetes, cancer and obesity.

Task Force 2 investigates the processes that are important for patients prior to device implantation, and makes recommendations for follow-up education, and psycho-social support.

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

Task Force 4 looks at the care of patients during post-operative phase and includes recommendations about psycho-social support, the factors that determine discharge from hospital and the common reasons for hospital re-admission.

Task Force 5 considers the long-term outpatient care of the MCS patient, and recommends that after returning home, patients should be managed by a multi-skilled team that includes cardiovascular surgeons and specialized MCS coordinators. It also emphasizes the importance of assessing the patient’s social network and care-providers and recommends that the patient and their caregivers should be trained to recognize MCS alarms.