THORACIC:AATS 2022 EXPERT CONSENSUS DOCUMENT:THE USE OF MECHANICAL CIRCULATORY SUPPORT IN LUNG TRANSPLANTATIONThe American Association for Thoracic Surgery (AATS)Check for updates2022 Expert Consensus Document:The use of mechanicalcirculatory support in lung transplantationExpert ConsensusMatthew Hartwig,MD(Co-Chair),Victor van Berkel,MD,PhD (Co-Chair),Panel:Ankit Bharat,MD,Marcelo Cypel,MD,Hiroshi Date,MD,PhD,Michiel Erasmus,MD,PhD,Konrad Hoetzenecker,MD,PhD,Walter Klepetko,MD,Zachary Kon,MD,"Jasleen Kukreja,MD,MPH,Tiago Machuca,MD,PhD,Kenneth McCurry,MD,Olaf Mercier,MD,'Isabelle Opitz,MD,T Varun Puri,MD,"andDirk Van Raemdonck,MD,PhDABSTRACTObjective:The use of mechanical circulatory support (MCS)in lung transplanta-tion has been steadily increasing over the prior decade,with evolving strategiesfor incorporating support in the preoperative,intraoperative,and postoperativesettings.There is significant practice variability in the use of these techniques,how-ever,and relatively limited data to help establish institutional protocols.The objec-tive of the AATS Clinical Practice Standards Committee(CPSC)expert panel was toreview the existing literature and establish recommendations about the use of MCSCRAPY YPAbefore,during,and after lung transplantation.Mechanical circulatory support plays animportantrole in supportinglungMethods:The AATS CPSC assembled an expert panel of 16 lung transplantation phy-transplantation.sicians who developed a consensus document of recommendations.The panel wasbroken into subgroups focused on preoperative,intraoperative,and postoperativeCENTRAL MESSAGEsupport,and each subgroup perfommed a focused literature review.These subgroupsMechanical circulatory support isformulated recommendation statements for each subtopic,which were evaluated byan important component ofthe entire group.The statements were then developed via discussion among the panelsupport for lung transplantationand refined until consensus was achieved on each statement.candidates and recipients in theResults:The expert panel achieved consensus on 36 recommendations for how andwhen to use MCS in lung transplantation.These recommendations included the use ofpreoperative,intraoperative,andveno-venous extracorporeal membrane oxygenation (ECMO)as a bridging strategy inpostoperative settings.the preoperative setting,a preference for central veno-arterial ECMO over traditionalcardiopulmonary bypass during the transplantation procedure,and the benefit of sup-PERSPECTIVEporting selected patients with MCS postoperatively.Mechanical circulatory support has had an ex-panding role in lung transplantation and is nowConclusions:Achieving optimal results in lung transplantation requires the use of ainvolved in preoperative stabilization,facilitationwide range of strategies.MCS provides an important mechanism for helping theseof the operation,and postoperative support Ancritically ill patients through the peritransplantation period.Despite the complex na-expert panel identifi
