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Indication for durable mechanical circulatory support: an expert opinion review
Felix Schoenrath1,2,3, Michael Bonios4, Attilio Iacovoni5
1Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Augustenburger Platz 1, Berlin 13353, Germany.
ESC Heart Failure
|July 21, 2026
Summary
Mechanical circulatory support is crucial for advanced heart failure. This review offers a pre-operative framework focusing on patient selection and multidisciplinary care for better outcomes.
Area of Science:
- Cardiology
- Medical Devices
Background:
- Advanced heart failure (AHF) presents a growing clinical challenge.
- Durable mechanical circulatory support (MCS) is a vital therapy for AHF, serving as a bridge to transplantation or a standalone treatment.
Purpose of the Study:
- To provide a contemporary clinical decision framework for AHF management.
- To supplement existing guidelines by emphasizing the pre-operative phase and multidisciplinary processes.
- To detail patient selection and optimization strategies for mitigating medical harm in complex AHF cases.
Main Methods:
- Expert review of current practices and guidelines in advanced heart failure care.
- Focus on pre-operative decision-making and optimization strategies.
- Emphasis on interdisciplinary team dynamics, workups, and shared decision-making.
Main Results:
- A structured approach to pre-operative assessment and optimization is essential for MCS success.
- Precise patient selection and management of comorbidities are critical for mitigating risks.
- Multidisciplinary collaboration and shared decision-making enhance equitable access and long-term survival.
Conclusions:
- The pre-operative phase is paramount for successful mechanical circulatory support in advanced heart failure.
- A comprehensive, multidisciplinary approach is necessary for optimizing patient selection and care.
- This framework aims to improve outcomes and ensure equitable access to advanced heart failure therapies.
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