2026 Chinese expert consensus on perioperative management for left ventricular assist device implantation in adults

Abstract Purpose This consensus was developed to address the lack of standardized perioperative management protocols for left ventricular assist device (LVAD) implantation in China and to build on recently published national consensus documents addressing preoperative and postoperative care. Given the increasing clinical use of domestically developed LVADs, context-specific guidance is needed. This consensus aimed to standardize perioperative care, reduce procedure-related complications, and improve outcomes in adults with end-stage heart failure undergoing LVAD implantation. Methods This expert consensus was jointly developed by the Chinese Society of Cardiothoracic Anesthesiology, the National Center for Cardiovascular Diseases Expert Committee, and the Beijing Medical Association. The consensus panel comprised 83 specialists from 41 clinical centers. The project development was registered on the Practice guideline REgistration for transPAREncy (PREPARE) platform (registration no. PREPARE-2025CN1348). Using the Population, Intervention, Comparator, and Outcomes (PICO) framework and the Delphi method, the panel systematically reviewed relevant international guidelines and peer-reviewed literature published through April 2026. Following evidence synthesis, multiple rounds of expert discussion, and formal voting, the panel developed 11 core recommendations. The certainty of the evidence and strength of the recommendations were assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results The recommendations address three phases of perioperative care: preoperative assessment, intraoperative management, and postoperative recovery. Preoperative recommendations emphasize assessment of right ventricular function, prediction of postoperative right heart failure, and evaluation of indications for LVAD implantation to support appropriate patient selection. Intraoperative recommendations specify hemodynamic targets, strategies for optimizing right ventricular performance, and blood-conservation measures intended to minimize transfusion requirements. Postoperative recommendations address multimodal analgesia and enhanced recovery after surgery (ERAS) protocols adapted to individual patient characteristics and institutional resources. The consensus also summarizes clinically relevant differences in the design and management of durable LVADs developed domestically and internationally to support device-specific care. Conclusions This consensus provides a structured, evidence-informed pathway for the perioperative management of adults undergoing LVAD implantation in China. By integrating international evidence with Chinese clinical experience and evidence involving domestically developed LVADs, the recommendations may improve the consistency and quality of perioperative care. Further evaluation is needed to determine their effects on postoperative complications and survival.