Task Force 4: Inpatient Management of Patients with MCSD - The ...

tamponade post-operatively, and there should be a low threshold for surgical
consultation when it is suspected.
Recommendations for the Treatment of Right Heart Dysfunction in the Non-ICU
Post-Operative Period:
Class I:
1. Inotropic support may need to be continued into the remote postoperative period (>2
weeks) when there is evidence for right heart dysfunction such as elevated JVP,
signs of venous congestion, decreased VAD flows (or low pulsatility in continuous
MCSD) or end-organ dysfunction. Once euvolemic, inotrope wean should be done
cautiously with ongoing examination for recurrent signs and symptoms of RV
dysfunction.
Level of Evidence: C.
2. For patients with persistent pulmonary hypertension who exhibit signs of RV
dysfunction, pulmonary hypertension-specific therapies such as PDE-5 inhibitors
should be considered.
Level of Evidence: C.
Class II
1. Diuretics and renal replacement therapy such as CVVH should be employed early
and continued as needed to maintain optimal volume status.
Level of Evidence: C.
2. Pacemaker therapy can be used if the heart rate is not optimal to support
hemodynamics.
Level of Evidence: C.
Recommendations for Managing Hypotension in the non-ICU Post-Operative
Period:
Class I:
1. A systematic approach to hypotension should be employed as shown in Figure 1.
Level of Evidence: C.
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