The 2023 International Society for Heart and Lung Transplantation Guidelines for Mechanical Circulatory Support: A 10-Year Update

The first official guidelines for implantable mechanical circulatory support (MCS) were published in 2013 by the International Society for Heart and Lung Transplantation (ISHLT). Ten years later, because of substantial advancements in the MCS field, much of the original report is no longer clinically relevant, so ISHLT commissioned a ten-year update. Like the 2013 MCS guidelines, the 2023 update are organized into individual task forces covering preoperative, intraoperative, and postoperative management of MCS patients treated with implantable left ventricular assist devices (LVADs), including four additional task forces, for a total of nine. With those additions, ISHLT says this 2023 guideline document is the most comprehensive resource guiding the management of patients with durable mechanical circulatory support (DMCS).

The nine task forces are as follows:

1. Selection of candidates for durable mechanical circulatory support (DMCS) and risk management before implantation for fixed comorbidities.
2.  Patient optimization, consent, and appropriate timing for MCS: Modifiable risk management before implantation.
3. Intraoperative and immediate postoperative management
4.  Inpatient management of patients with DMCS.
5. Outpatient management of the mechanical circulatory support device recipient.
6. VAD in adults with congenital heart disease.
7. Evaluation for recovery.
8. Biventricular assist devices and total artificial heart specifications.
9. Center quality metrics, outcomes, volume, and staffing.