Destination Mechanical Circulatory Support: Proposal for Clinical Standards

Published 1 April 2003

M.C Deng, MD; J.B Young, MD; L.W Stevenson, MD; M.C Oz, MD; E.A Rose, MD; S.A Hunt, MD; J.K Kirklin, MD; J Kobashigawa, MD; L Miller, MD; M Saltzberg, MD; M Konstam, MD; P.M Portner, MD, PhD; R Kormos, MD

J Heart Lung Transplant. 2003 Apr;22(4):365-9

• Advanced Heart Failure & Transplantation
• Cardiology
• Cardiothoracic Surgery
• Editorial
• Mechanical Circulatory Support
• Nursing & Allied Health
• Publications & Journals
• Standards & Guidelines

Mechanical circulatory support device (MCSDs) have evolved during the past 2 decades to become accepted bridging therapy for patients with irreversible hemodynamic deterioration while awaiting cardiac transplantation. More recently, MCSD therapy has become available as permanent or destination therapy for a restricted population of patients with advanced heart failure (AHF) not thought to be appropriate transplant candidates. The potential proliferation of new devices and the possible expansion of the target populations bring new responsibilities.

To ensure high-quality and maximally effective destination MCSD services, a systematic strategy should be developed including 1) documentation of all destination MCSD implantations in an appropriate registry to facilitate risk-factor identification and the development of predictive models; 2) translational research on the impact of MCSD therapy on innate and adaptive immune responses, infection, coagulopathies, neurologic dysfunction, and nutritional status; 3) expeditious and coordinated improvement of management practices; and 4) development of reimbursement rules and development of center standards for hospitals desiring to perform long-term MCSD therapy by regulatory bodies, such as the Centers for Medicare and Medicaid Services in the United States.

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