A Pragmatic Approach to Weaning Temporary Mechanical Circulatory Support: A State-of-the-Art Review

Varinder Kaur Randhawa, Abdulrahman Al-Fares, Michael Z.Y. Tong, Edward G. Soltesz, Jaime Hernandez-Montfort, Ziad Taimeh, Aaron J. Weiss, Venu Menon, Joseph Campbell, Paul Cremer, Jerry D. Estep*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

41 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)664-673
Number of pages10
JournalJACC: Heart Failure
Volume9
Issue number9
DOIs
StatePublished - Sep 2021

Keywords

  • explant
  • myocardial recovery
  • temporary mechanical circulatory support
  • weaning

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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