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A Pragmatic Approach to Weaning Temporary Mechanical Circulatory Support
JACC: Heart Failure ( IF 13.0 ) Pub Date : 2021-08-11 , DOI: 10.1016/j.jchf.2021.05.011
Varinder Kaur Randhawa 1 , Abdulrahman Al-Fares 2 , Michael Z Y Tong 3 , Edward G Soltesz 3 , Jaime Hernandez-Montfort 4 , Ziad Taimeh 1 , Aaron J Weiss 3 , Venu Menon 1 , Joseph Campbell 1 , Paul Cremer 1 , Jerry D Estep 1
Affiliation  

Temporary mechanical circulatory support (TMCS) provides short-term support to patients with or at risk of refractory cardiogenic shock. Although indications, contraindications, and complications of TMCS may guide device selection, optimal strategies for device weaning and explant remain poorly defined. Under the revised adult heart allocation policy implemented by the United Nations for Organ Sharing in October 2018, rejustification of heart transplant listing status includes demonstrating TMCS dependency with attempted device wean trials. However, standardized device-specific weaning and explant protocols have not been proposed or evaluated. This review highlights when to use percutaneous TMCS in cardiogenic shock, with a focus on weaning and explant considerations. Terminology for important concepts that guide device escalation, de-escalation, and explantation have been defined. Clinical, hemodynamic, metabolic, and imaging features have been defined, which can guide a tailored approach to TMCS weaning and explant based on the approach used at the Cleveland Clinic. A narrative review of published studies that have reported TMCS weaning protocols and survey results of member centers from CS-MCS working group centers is also provided. Future research is needed to better understand optimal timing and implementation of standardized protocols to achieve successful TMCS weaning and explant.



中文翻译:

撤除临时机械循环支持的实用方法

临时机械循环支持 (TMCS) 为患有难治性心源性休克或有难治性心源性休克风险的患者提供短期支持。尽管 TMCS 的适应症、禁忌症和并发症可能会指导设备选择,但设备撤机和外植体的最佳策略仍不明确。根据联合国于 2018 年 10 月为器官共享实施的修订后的成人心脏分配政策,心脏移植列表状态的重新调整包括通过尝试装置撤机试验证明 TMCS 依赖性。然而,尚未提出或评估标准化的特定于设备的断奶和外植体方案。这篇综述强调了何时在心源性休克中使用经皮 TMCS,重点是撤机和外植体的考虑。指导设备升级、降级、和解释已经定义。临床、血流动力学、代谢和影像学特征已经确定,可以根据克利夫兰诊所使用的方法指导 TMCS 脱机和外植的定制方法。还提供了对已发表的研究的叙述性审查,这些研究报告了 TMCS 脱机协议和来自 CS-MCS 工作组中心的成员中心的调查结果。未来的研究需要更好地理解标准化协议的最佳时机和实施,以实现成功的 TMCS 断奶和外植。还提供了对已发表的研究的叙述性审查,这些研究报告了 TMCS 脱机协议和来自 CS-MCS 工作组中心的成员中心的调查结果。未来的研究需要更好地理解标准化协议的最佳时机和实施,以实现成功的 TMCS 断奶和外植。还提供了对已发表的研究的叙述性审查,这些研究报告了 TMCS 脱机协议和来自 CS-MCS 工作组中心的成员中心的调查结果。未来的研究需要更好地理解标准化协议的最佳时机和实施,以实现成功的 TMCS 断奶和外植。

更新日期:2021-08-31
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