Journal of Cardiac Failure Vol.29 No.4 2023Review ArticleHFSA Expert Consensus Statement on the MedicalManagement of Patients on Durable Mechanical CirculatorySupportBARRY TRACHTENBERG,MD,1 JENNIFER COWGER,MD,MS,2 DOUGLAS L.JENNINGS,PharmD,3 GILLIAN GRAFTON,DO,4RENZO LOYAGA-RENDON,MD,REBECCA COGSWELL,MD,MS,LIVIU KLEIN,MD,'PALAK SHAH,MD,MS,MICHAEL KIERNAN,MD,3 AND ESTHER VOROVICH,MD,MSCE10Houston,Texas;Detroit,and Grand Rapids,Michigan;New York,New York;Minneapolis,Minnesota;San Francisco,California;Virginia;Massachusetts;and Evanston,lllinoisABSTRACTThe medical management of patients supported with durable continuous flow left ventricularassist device(LVAD)support encompasses pharmacological therapies administered in the preop-erative,intraoperative,postoperative,and chronic LVAD support stages.As patients live longeron LVAD support,the risks of LVAD-related complications and progression of cardiovascular andother diseases increase.Using existing data from cohort studies,registries,randomized trials,andexpert opinion,this Heart Failure Society of America Consensus Document on the Medical Man-agement of Patients on Durable Mechanical Circulatory Support offers best practices on the man-agement of patients on durable mechanical circulatory support,focusing on pharmacologicaltherapies administered to patients on continuous flow LVADs.Although quality data in the LVADpopulation are few,the use of guideline-directed heart failure medical therapies and the impor-tance of blood pressure management,right ventricular preload and afterload optimization,andantiplatelet and anticoagulation regimens are discussed.Recommended pharmacological regi-mens used to mitigate or treat common complications encountered during LVAD support,incud-ing arrhythmias,vasoplegia,mucocutaneous bleeding,and infectious complications,areaddressed.Finally,this document touches on important potential pharmacological interactionsfrom antidepressants and herbal and nutritional supplements of relevance to providers ofpatients on LVAD support.(J Cardiac Fail 2023;29:479-502)Key Words:Mechanical circulatory support,left ventricular assist device,right ventricular fail-ure,vasoplegia,driveline infection,pulmonary hypertension.From the 'Houston Methodist Heart and Vascular Center,Meth-Center,6400 Fannin,Suite 3000,Houston TX 77030.Phone:713-odist J.C.Walter Transplant Center,Houston,Texas;"Mechanical Cir-790-0841.E-mail:btrachtenberg houstonmethodist.orgculatory Support Program,Cardiac Critical Care,Henry FordDisclosures:Jennifer Cowger serves as a consultant for Abbott;Advanced Heart Failure Program,Detroit,Michigan;New York-on the steering committee/advisory board for Medtronic,Endo-Presbyterian Hospital Columbia University Medical Center,Newtronix,Procyrion,Bioventrix,Nuwellis,and BiVacor;and as aYork,New York;"Henry Ford Hospital,Detroit,Michigan;Spectrumspeaker for Abbott,Bioventix,and Zoll.Palak Shah is supportedHealth,Grand Rapids,Michigan University of Minnesota,Minneap-by NIH K23 C
