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Preoperative Strategies for Optimizing Mechanical Circulatory Support 

Preoperative Strategies for Optimizing Mechanical Circulatory Support
Chapter:
Preoperative Strategies for Optimizing Mechanical Circulatory Support
Author(s):

Evan C. Klein

and Mitchell T. Saltzberg

DOI:
10.1093/med/9780190909291.003.0007
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date: 02 December 2020

Several validated risk models can help determine whether patients with advanced heart failure should be considered for mechanical circulatory support based on its potential survival advantage. Once a patient is a candidate for device therapy, an understanding of these risk models can help inform decisions about modifying risk factors to provide the best postsurgical outcomes. Specific preoperative factors that can be addressed include the adequacy of perfusion, volume status, and the status of non-cardiac organ systems (e.g., the pulmonary, infectious, hematologic, renal systems). Additionally, an understanding of preoperative right ventricular hemodynamics and function can help alert providers to patients with an increased need for postoperative right-ventricular support. The chapter reviews several risk-stratification models, as well as the approach used by the authors’ institution to optimize the preoperative treatment of patients before implementing mechanical circulatory support.

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