Recommendation   Class   Level   References
Device malfunction
It is recommended that out-patient management encompass regular evaluation and inspection of the technical parameters and all components of the external part of the device and their connections.  I  C  [416]
It is recommended that in cases of pump malfunction with clinical symptoms, the patient is assisted by emergency medical service and referred to the implanting centre.  I  C  [417, 418]
Surveillance by abdominal radiogram to regularly assess internal components of the driveline may be considered.  IIb  C
In case of damage to the external parts of the driveline, splice repair of the wires in the operating room by technical personnel, with a surgery team on standby, should be considered.  IIa  C  [439]
In-hospital evaluation is recommended for pump alarms signalling pump malfunction.  I  C
Pump thrombosis
In the case of a clinical thrombotic event, pump evaluation for device thrombosis is recommended.  I  C  [422, 440]
Evaluation of the presence of pump thrombosis is recommended if flow alarms are present.  I  C  [422, 440]
In the case of a flow obstruction, technical, clinical and diagnostic investigations of the outflow graft, pump body and inflow cannula are recommended.  I  C  [422, 440]
Routine monitoring of lactate dehydrogenase and plasma free haemoglobin levels during follow-up is recommended.  I  C  [441]
In the case of pump thrombosis of a HeartWare HVAD, device exchange should be considered.  IIa  C  [424, 426]
In the case of pump thrombosis of a HeartWare HVAD, thrombolysis may be considered.  IIb  C  [424, 426]
In the case of pump thrombosis of a HeartMate II, device exchange or a high-urgency heart transplant (if possible) should be considered.  IIa  C  [424]
In a scenario of prepump (inflow graft) thrombosis, a backwash with carotid artery protection may be considered.  IIb  C  [442]
In a scenario of post-pump (outflow graft) thrombosis, stenting should be considered.  IIa  C  [422, 427, 443–446]
Events of bleeding during LT-MCS
For a major bleeding event, temporary discontinuation of anticoagulation therapy is recommended.  I  C
For a critical clinical bleeding episode or if the international normalized ratio is >4, anticoagulation reversal is recommended.  I  C
If gastrointestinal bleeding is recurrent, discontinuation of platelet inhibitors should be considered.  IIa  C  [428]
Evaluation of other causative factors that might influence the risk of gastrointestinal bleeding should be considered.  IIa  C  [35, 117, 447–449]
In cases of occult recurrent bleeding despite the use of the above measures, octreotide or thalidomide may be considered.  IIb  C  [430, 431]
Prevention and treatment of cerebrovascular accidents
A target mean arterial pressure <85 mmHg to reduce the risk of stroke is recommended.  I  B  [377, 433, 434]
Computed tomography angiography is recommended for vascular imaging and endovascular treatment of ischaemic stroke.  I  A  [450]
In cases of acute neurological deficit, emergent neuroimaging with computed tomographic scans is recommended.  I  A  [450]
Reversal of coagulopathy with prothrombin complex concentrates or transfusions with fresh frozen plasma and platelets is recommended for treatment of haemorrhagic stroke.  I  A  [451, 452]
Cardiac arrhythmias
In patients with long-term mechanical circulatory support who develop postoperative ventricular arrhythmia with haemodynamic compromise, ICD implantation is recommended.  I  C  [438]
To prevent adverse sequelae of right ventricular dysfunction, continuation of ICD therapy should be considered.  IIa  C  [435]
Prophylactic ICD implantation in patients without arrhythmias at the time of long-term mechanical circulatory support implantation is not recommended.  III  C  [437, 438, 453]