PMC:6640909 / 17944-21460 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/6640909","sourcedb":"PMC","sourceid":"6640909","source_url":"https://www.ncbi.nlm.nih.gov/pmc/6640909","text":"Recommendation Class Level References\nMalignancies\nEvaluation for malignancies is recommended. I A\nIn patients with a proven malignancy and an expected survival of \u003c1 year, implantation of long-term mechanical circulatory support is not recommended. III C\nPulmonary hypertension\nInvasive haemodynamic assessment of pulmonary vascular resistance is recommended. I C [107]\nIn heart transplant candidates, normalization of elevated pulmonary vascular resistance in patients on long-term mechanical circulatory support should be considered. IIa B [108, 109, 130, 131]\nCardiac cachexia\nAssessment of frailty and nutritional status using a frailty score and/or prognostic nutrition index prior to implantation of long-term mechanical circulatory support may be considered. IIb C [48, 96]\nRenal dysfunction\nImplantation of long-term mechanical circulatory support should be considered in case of reversible secondary renal dysfunction. IIa C [37, 56, 71, 103]\nImplantation of long-term mechanical circulatory support may be considered in patients on chronic haemodialysis. IIb C [37, 56, 103]\nNeurological function and disorders\nCareful neurological examination is recommended for all candidates for implantation of long-term mechanical circulatory support including assessment of dementia and mental status. I C [104, 132]\nMultidisciplinary evaluation of prognosis of survival and morbidity of patients with neuromuscular disorders is recommended. I C [133]\nAdherence (medical therapy, alcohol, tobacco, psychological, psychiatric and social derangement)\nScreening for psychological and psychiatric (including cognitive function) disorders and substance abuse is recommended. I C [104]\nIt is recommended that adherence (tobacco, alcohol and substance abuse), psychosocial risks and familial support be evaluated. I C [134]\nIn patients with frailty, psychiatric or neurological disorders, evaluation of their ability to operate the device is recommended. I C\nVascular disease\nScreening for peripheral vascular disease is recommended. I C [67]\nCoagulation and haematological disorders\nEvaluation of all long-term mechanical circulatory support candidates for coagulopathies and hypercoagulable states (e.g. thrombophilia) is recommended. I C [135]\nIn patients with thrombocytopenia after exposure to heparin, testing for heparin-induced thrombocytopenia should be considered. IIa C [136]\nRespiratory considerations\nSpirometry as part of the patient work-up should be considered. IIa C [25, 37, 137]\nPreoperative thoracic imaging should be considered as part of the overall risk/benefit evaluation. IIa C [25, 37, 137]\nDiabetes\nScreening for diabetes mellitus (including end-organ damage) before implant of long-term mechanical circulatory support is recommended. For patients with poorly controlled diabetes, consultation with a diabetologist is recommended. I C\nImplantation of long-term mechanical circulatory support in patients with diabetes with severe end-organ complications is not recommended. III C\nGastrointestinal disorders\nGastrointestinal bleeding in patients 50 years or older: faecal occult blood testing, gastroscopy and endoscopy should be considered. IIa C [116, 117]\nPregnancy\nContraception in women of childbearing age after implant of long-term mechanical circulatory support is recommended. I C\nLong-term mechanical circulatory support in the setting of pregnancy is a multidisciplinary challenge and may be considered. 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