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The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

American Association for Thoracic Surgery/International Society for Heart and Lung Transplantation guidelines on selected topics in mechanical circulatory support

Published:January 23, 2020DOI:https://doi.org/10.1016/j.healun.2020.01.1329
      Mechanical circulatory support (MCS) evolved from an engineering dream to clinical reality during the 1980s when increasing numbers of patients were dying on heart transplant wait lists. Following the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure Trial,
      • Rose E.A.
      • Gelijns A.C.
      • Moskowitz A.J.
      • Heitjan D.F.
      • Stevenson L.W.
      • Dembitsky W.
      • et al.
      Long-term use of a left ventricular assist device for end-stage heart failure.
      the US Food and Drug Administration (FDA) approved a pulsatile implantable left ventricular assist device (LVAD) for long-term implantation in 2002. When the FDA approved the first US continuous flow (CF) LVAD in 2008, the landscape had changed dramatically. With demonstrated survival on device exceeding 80% at 1 year,
      • Kirklin J.K.
      • Pagani F.D.
      • Kormos R.L.
      • Stevenson L.W.
      • Blume E.D.
      • Myers S.L.
      • et al.
      Eighth annual INTERMACS report: special focus on framing the impact of adverse events.
      implants in the United States progressively increased to nearly 3000 per year. With the maturation of this field, guidelines for patient care and decision making have become more evidenced-based. This consensus guidelines document focuses on selected topics in patient management. The writing group included 25 surgeons and 10 heart failure cardiologists. After review and evaluation of available literature and incorporation of their collective experience, specific recommendations were assigned a class and level of evidence (Table 1).
      • Svensson L.G.
      • Gillinov A.M.
      • Weisel R.D.
      • Keshavjee S.
      • Bacha E.A.
      • Moon M.R.
      • et al.
      The American Association for Thoracic Surgery consensus guidelines: reasons and purpose.
      ,
      • Bakaeen F.G.
      • Svensson L.G.
      • Mitchell J.D.
      • Keshavjee S.
      • Patterson G.A.
      • Weisel R.D.
      The American Association for Thoracic Surgery/Society of Thoracic Surgeons position statement on developing clinical practice documents.
      Table 1American Association for Thoracic Surgery/International Society for Heart and Lung Transplantation Guidelines Grading Criteria
      • Svensson L.G.
      • Gillinov A.M.
      • Weisel R.D.
      • Keshavjee S.
      • Bacha E.A.
      • Moon M.R.
      • et al.
      The American Association for Thoracic Surgery consensus guidelines: reasons and purpose.
      ,
      • Bakaeen F.G.
      • Svensson L.G.
      • Mitchell J.D.
      • Keshavjee S.
      • Patterson G.A.
      • Weisel R.D.
      The American Association for Thoracic Surgery/Society of Thoracic Surgeons position statement on developing clinical practice documents.
      Class I Evidence and/or general agreement that a given treatment or procedure is beneficial, useful, and effective
      Class II Conflicting evidence and/or divergence of opinion about the usefulness/efficacy of the treatment or procedure
      Class IIa Weight of evidence/opinion is in favor of usefulness/efficacy
      Class IIb Usefulness/efficacy is less well established by evidence/opinion
      Class III Evidence or general agreement that the treatment or procedure is not useful or effective and in some cases may be harmful
      Level of Evidence A Data derived from multiple randomized clinical trials or meta-analyses
      Level of Evidence B Data derived from a single randomized clinical trial or large non-randomized studies
      Level of Evidence C Consensus of opinion of the experts and/or small studies, retrospective studies, registries

      KeyWords

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