Long-term mechanical circulatory support (LT-MCS) is an important treatment modality for patients with severe heart failure. Different devices are available, and many-sometimes contradictory-observations regarding patient selection, surgical techniques, perioperative management and follow-up have been published. With the growing expertise in this field, the European Association for Cardio-Thoracic Surgery (EACTS) recognized a need for a structured multidisciplinary consensus about the approach to patients with LT-MCS. However, the evidence published so far is insufficient to allow for generation of meaningful guidelines complying with EACTS requirements. Instead, the EACTS presents an expert opinion in the LT-MCS field. This expert opinion addresses patient evaluation and preoperative optimization as well as management of cardiac and non-cardiac comorbidities. Further, extensive operative implantation techniques are summarized and evaluated by leading experts, depending on both patient characteristics and device selection. The faculty recognized that postoperative management is multidisciplinary and includes aspects of intensive care unit stay, rehabilitation, ambulatory care, myocardial recovery and end-of-life care and mirrored this fact in this paper. Additionally, the opinions of experts on diagnosis and management of adverse events including bleeding, cerebrovascular accidents and device malfunction are presented. In this expert consensus, the evidence for the complete management from patient selection to end-of-life care is carefully reviewed with the aim of guiding clinicians in optimizing management of patients considered for or supported by an LT-MCS device.

Advanced Heart Failure and Mechanical Circulatory Support Program Cardiac Intensive Care San Raffaele Hospital Vita Salute University Milan Italy

Clinic for Thoracic and Cardiovascular Surgery Herz und Diabeteszentrum Nordrhein Westfalen Bad Oeynhausen Germany

Complexo Hospitalario Universitario A Coruña CIBERCV UDC La Coruña Spain

Department of Anaesthesiology German Heart Center Berlin Berlin Germany

Department of Anesthesia and Intensive Care San Raffaele Hospital Vita Salute University Milan Italy

Department of Cardiology Rigshospitalet Copenhagen Denmark

Department of Cardiology University Medical Center Utrecht Utrecht Netherlands

Department of Cardiothoracic and Vascular Surgery German Heart Center Berlin Germany; DZHK Partner Site Berlin Germany

Department of Cardiothoracic S Orsola Hospital Transplantation and Vascular Surgery University of Bologna Bologna Italy

Department of Cardiothoracic Surgery Erasmus University Medical Center Rotterdam Netherlands

Department of Cardiothoracic Surgery Jena University Hospital Friedrich Schiller University of Jena Jena Germany

Department of Cardiovascular Surgery Ege University Izmir Turkey

Department of Cardiovascular Surgery Swiss Cardiovascular Center Inselspital Bern University Hospital Bern Switzerland

Department of Congenital Pediatric Surgery Zurich Children's Hospital Zurich Switzerland

Department of Medical Microbiology University College of Dublin Dublin Ireland

Department of Medicine Karolinska Institute Heart and Vascular Theme Karolinska University Hospital Solna Sweden

Department of Surgery Division of Cardiac Surgery Medical University of Vienna Vienna Austria

Institute for Clinical and Experimental Medicine Prague Czech Republic

Royal Papworth Hospital Cambridge United Kingdom

Service de médecine intensive réanimation Institut de Cardiologie APHP Hôpital Pitié Salpêtrière Paris France

Sorbonne Université INSERM Institute of Cardiometabolism and Nutrition Paris France

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Drug therapy and catheter ablation for management of arrhythmias in continuous flow left ventricular assist device's patients: a Clinical Consensus Statement of the European Heart Rhythm Association and the Heart Failure Association of the ESC