EACTS Expert Consensus Document on protected cardiac surgery: pre-emptive use of temporary mechanical circulatory support in adult cardiac surgery patients at high risk for perioperative low cardiac output syndrome

Perioperative low cardiac output syndrome (LCOS) remains a significant complication in adult cardiac surgery, contributing to substantial morbidity, prolonged intensive care, and increased mortality. Its incidence is expected to rise further due to the evolving complexity of referred surgical patients, often characterised by advanced age, multiple comorbidities, challenging anatomy, and impaired haemodynamics. Despite advances in pharmacological and perioperative care, outcomes for high-risk patients have not shown significant improvement, prompting interest in temporary mechanical circulatory support (tMCS) as a proactive strategy. This Expert Consensus Document from the European Association for Cardio-Thoracic Surgery (EACTS) presents the first dedicated guidance on the pre-emptive use of tMCS in high-risk adult cardiac surgical patients. Developed by a multidisciplinary task force, it emphasises structured risk stratification, early initiation, and individualised device management informed by interdisciplinary Heart Team discussions. The document proposes clinical pathways for patient selection, defines criteria for tMCS initiation, and provides practical algorithms for various scenarios, including advanced heart failure, cardiogenic shock, and post-cardiotomy LCOS. It reviews the current evidence on available tMCS devices, such as intra-aortic balloon pumps, microaxial flow pumps, veno-arterial extracorporeal life support and hybrid strategies, and addresses perioperative care, intensive care unit protocols, ethical considerations, as well as informed consent and support withdrawal. Despite promising results, substantial knowledge gaps remain, including long-term outcome data, device selection criteria, and cost-effectiveness analyses. This consensus aims to support clinical decision-making, standardise practice, and stimulate research to improve outcomes in a growing population of high-risk surgical patients.

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Publication Details

Journal
European Journal of Cardio-Thoracic Surgery
Published
2025-10-02
DOI
https://doi.org/10.1093/ejcts/ezaf296
Citations
1
Primary Topic
Mechanical Circulatory Support Devices
Type
article
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0.67
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article

EACTS Expert Consensus Document on protected cardiac surgery: pre-emptive use of temporary mechanical circulatory support in adult cardiac surgery patients at high risk for perioperative low cardiac output syndrome

Yoan Lamarche, Gaik Nersesian, Domenico Paparella, Dominik Wiedemann et al.
1 citations
European Journal of Cardio-Thoracic Surgery
Mechanical Circulatory Support Devices
0.67
article

EACTS Expert Consensus Document on protected cardiac surgery: pre-emptive use of temporary mechanical circulatory support in adult cardiac surgery patients at high risk for perioperative low cardiac output syndrome

Yoan Lamarche, Gaik Nersesian, Domenico Paparella, Dominik Wiedemann, Louis H. Stein, Claudio Russo, Scott Silvestry, Daniel Zimpfer, Joseph E. Tonna, Edward G. Soltesz, Graeme MacLaren, Roberto Lorusso, Evgenij Potapov, Michiel Morshuis, Hiroo Takayama, Massimiliano Meineri, Marko Turina, Christoph Knosalla, Rakesh C. Arora, Bart Meyns, Thomas Fux, Udo Boeken, Bastian Schmack, C. Bermúdez, Gloria Färber, Jonathan W. Haft, Daniel T. Engelman, Bhavesh Patel, Koji Takeda, Daniel Goldstein, Ulrik Sartipy, Leonardo Salazar, Pedro Moreno, Glenn Whitman, V. Rao, Milan Milojevic
article en
1 citations

Abstract

Perioperative low cardiac output syndrome (LCOS) remains a significant complication in adult cardiac surgery, contributing to substantial morbidity, prolonged intensive care, and increased mortality. Its incidence is expected to rise further due to the evolving complexity of referred surgical patients, often characterised by advanced age, multiple comorbidities, challenging anatomy, and impaired haemodynamics. Despite advances in pharmacological and perioperative care, outcomes for high-risk patients have not shown significant improvement, prompting interest in temporary mechanical circulatory support (tMCS) as a proactive strategy. This Expert Consensus Document from the European Association for Cardio-Thoracic Surgery (EACTS) presents the first dedicated guidance on the pre-emptive use of tMCS in high-risk adult cardiac surgical patients. Developed by a multidisciplinary task force, it emphasises structured risk stratification, early initiation, and individualised device management informed by interdisciplinary Heart Team discussions. The document proposes clinical pathways for patient selection, defines criteria for tMCS initiation, and provides practical algorithms for various scenarios, including advanced heart failure, cardiogenic shock, and post-cardiotomy LCOS. It reviews the current evidence on available tMCS devices, such as intra-aortic balloon pumps, microaxial flow pumps, veno-arterial extracorporeal life support and hybrid strategies, and addresses perioperative care, intensive care unit protocols, ethical considerations, as well as informed consent and support withdrawal. Despite promising results, substantial knowledge gaps remain, including long-term outcome data, device selection criteria, and cost-effectiveness analyses. This consensus aims to support clinical decision-making, standardise practice, and stimulate research to improve outcomes in a growing population of high-risk surgical patients.

European Journal of Cardio-Thoracic SurgeryVol. 68(3)
Northwestern University (US), Newark Beth Israel Medical Center (US), Cleveland Clinic (US), Montefiore Medical Center (US), Baystate Medical Center (US), NewYork–Presbyterian Hospital (US), University of Arizona (US), Johns Hopkins University (US), University of Utah (US), Cardiovascular Institute of the South (US), University of Michigan (US), University Hospitals of Cleveland (US), Columbia University Irving Medical Center (US), Hospital of the University of Pennsylvania (US), Johns Hopkins Medicine (US), Pennsylvania Hospital (US), Maastricht University Medical Centre (NL), Universitair Ziekenhuis Leuven (BE), Montreal Heart Institute (CA), Toronto General Hospital (CA), Medizinische Hochschule Hannover (DE), Humboldt-Universität zu Berlin (DE), Düsseldorf University Hospital (DE), Fundación Cardiovascular de Colombia (CO), University Hospital of Zurich (CH), Mount Sinai Hospital (US), Deutsches Herzzentrum der Charité (DE), University Hospitals Cleveland Medical Center (US), Michigan Medicine (US), Universitätsklinikum St. Pölten (AT), Institute for Cardiovascular Diseases of Vojvodina (RS), Baystate Health (US), Universitätsklinikum Würzburg (DE), German Centre for Cardiovascular Research (DE), Mayo Clinic Hospital (US), National University Hospital (SG), Karl Landsteiner University of Health Sciences (AT), Johns Hopkins Hospital (US), Escuela Internacional de Negocios y Desarrollo Empresarial de Colombia (CO), Heinrich Heine University Düsseldorf (DE), Medical University of Vienna (AT), Charité - Universitätsmedizin Berlin (DE)
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Mechanical Circulatory Support Devices
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