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

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1. The MCS team should be made aware when an MCS patient is undergoing a NCP so that collaboration between the MCS and surgical teams can take place. Level of Evidence: C. 2. For non-emergent procedures, warfarin and antiplatelet therapy may be continued if the risk of bleeding associated with the procedure is low. If therapy needs to be stopped, warfarin and antiplatelet therapy should be held for an appropriate period of time as determined by the type of procedure being undertaken and risk of bleeding. Bridging with heparin or heparin-alternative while a patient is off warfarin may be considered. Level of Evidence: C. 3. For emergent procedures, warfarin may need to be rapidly reversed with FFP or PCC. Vitamin K can be administered but has slower onset of action. Level of Evidence: B. 4. Post-procedure, warfarin and antiplatelet therapy may be resumed when risk of surgical bleeding is deemed acceptable. Patients may be bridged with heparin or heparin alternative while waiting for the INR to reach the target range. Level of Evidence: B 5. During minor procedures, blood pressure monitoring with Doppler is appropriate. Level of Evidence: C. 6. During procedures with risk of hemodynamic instability, an arterial line should be placed for blood pressure monitoring. Level of Evidence: C. 7. A central venous catheter may be placed for monitoring of central venous pressure and to administer drugs in the case of hemodynamic instability during surgical procedures of moderate or high risk. Level of Evidence: B. 8. During NCP, MCSD parameters should be continuously monitored by expert personnel such as MCS nurses or perfusionists. Level of Evidence: C. 9. A cardiovascular surgeon should be in the operating room or immediately available, especially in situations when the NCP is in close proximity to the MCSD itself. 40
Level of Evidence: C. Class II: 1. Whenever possible, the surgeon performing the NCP should have experience in operating on patients with MCSD. Level of Evidence: C. 41
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Page 3 and 4: additive benefits on mean pulmonary
Page 5 and 6: Recommendations for Neurohormonal B
Page 7 and 8: in Task Force 3. Some surgeons elec
Page 9 and 10: MCSD surgery is advised. 19 Preoper
Page 11 and 12: catheter care. 34 The same techniqu
Page 13 and 14: 3. Pre-albumin and C-reactive prote
Page 15 and 16: those patients with learning disabi
Page 17 and 18: may also be related to the type of
Page 19 and 20: appointments after discharge from M
Page 21 and 22: domains of HRQOL (e.g., depression,
Page 23 and 24: For patients who present with gastr
Page 25 and 26: amenable to endoscopic or surgical
Page 27 and 28: INTERMACS also mandates administrat
Page 29 and 30: 6. Discontinuation or reversal of a
Page 31 and 32: Infectious Issues The classificatio
Page 33 and 34: Level of Evidence: B. 3. A possible
Page 35 and 36: Recommendations for Inpatient Treat
Page 37 and 38: could be actuated with a hand pump
Page 39: heparin, or a heparin-alternative,
Page 43 and 44: 19. Holman WL, Rayburn BK, McGiffin
Page 45 and 46: 60. McGrady A, McGinnis R, Badenhop
Page 47 and 48: 98. Cadeiras M, Nagaraj H, Kirklin
Page 49 and 50: Table 1. Causes of Deviation from N
Page 51 and 52: Table 3. Determination of MCSD Infe
Page 53: B. Deep MCSD-specific Percutaneous

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

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