Abstract
The medical management of patients supported with durable continuous flow left ventricular
assist device (LVAD) support encompasses pharmacologic 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 MCS, focusing
on pharmacological therapies administered to patients on continuous flow LVADs. While
quality data in the LVAD population are few, the utilization of guideline directed
heart failure medical therapies (GDMT) and the importance of blood pressure management,
right ventricular preload and afterload optimization, and antiplatelet and anticoagulation
regimens are discussed. Recommended pharmacologic 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 anti-depressants,
herbal and nutritional supplements of relevance to providers of patients on LVAD support.
Graphical Abstract
Graphical Abstract
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Article info
Publication history
Accepted:
January 20,
2023
Received:
January 17,
2023
Publication stage
In Press Journal Pre-ProofFootnotes
Disclosures: Cowger: consultant for Abbott; Steering Committee/Advisory Board for Medtronic, Endotronix, Procyrion, Bioventrix, Nuwellis, BiVacor; speaker for Abbott, Bioventix, and Zoll. Shah: Supported by NIH K23 Career Development Award 1K23HL143179, Grant support paid to institution from Abbott, Roche, Merck and Bayer, Consultant for Merck and Procyrion
Trachtenberg: Speaker/Consultant for Pfizer, Speaker for Alnylam, Consultant Abbott
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© 2023 Elsevier Inc. All rights reserved.
