Recommendations for preoperative organ function optimization
Recommendation   Class   Level   References
Renal function
In patients with renal dysfunction, optimization via improvement of cardiac output and reduction of filling pressures is recommended.  I  B  [56]
Liver function
Liver function evaluation with bilirubin is recommended.  I  B  [57, 58]
In patients with increasingly elevated bilirubin levels, temporary MCS, ahead of possible LT-MCS implantation, may be considered.  IIb  B  [59]
Pulmonary function
Treatment of preimplant pulmonary oedema is recommended before implantation.  I  B  [60, 61]
Left ventricular unloading on extracorporeal life support to optimize lung function should be considered.  IIa  B  [62]
Respiratory physiotherapy should be considered.  IIa  C
Coagulation
Withdrawal of dual antiplatelet therapy and/or vitamin K antagonists to reduce the risk of bleeding is recommended.  I  B  [63, 64]
The use of short-acting intravenous anticoagulation as bridging is recommended.  I  B  [64]
Administration of procoagulants shortly before implantation of the LT-MCS may be considered.  IIb  B  [64]
Optimization of coagulation prior to surgery should be considered, especially in patients on temporary MCS.  IIa  C
Nutritional, metabolic and endocrine considerations
Preoperative assessment of metabolic, endocrine and nutritional status, including possible interventions for arising issues, should be considered.  IIa  C
Nutritional support, if necessary, may be considered.  IIb  C  [65, 66]
LT-MCS: long-term mechanical circulatory support.