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The field of mechanical circulatory support (MSC) has made tremendous progress in the past 15 years. Thousands of patients worldwide have undergone implantation of long-term MSC devices (MCSDs). Currently, management of patients with MCSDs has been guided by individual clinicians and center-specific protocols. There have been few randomized studies to guide patient selection and care of the MCS patient. Short-term success with MCS therapy largely depends on patient selection, surgical technique, and post-operative management. Long-term success depends on physician and patient engagement in excellent care of their device and personal health. The International Society for Heart and Lung Transplantation (ISHLT) has made a commitment to convene an international and multidisciplinary panel of experts in MCS care.

It is important to note that every effort has been made to include as contributing writers cardiologists, cardiac surgeons, MCS coordinators, and other members of the multidisciplinary team. Because the guidelines are international, we also tried to balance perspective from different countries as best possible.

As the reader of these guidelines will observe, most of the recommendations are level of evidence C or consensus agreement. Gaps in evidence are highlighted where appropriate. Because MCS is an evolving field, device availability varies from center to center. We aim to address general issues of long-term use and not to focus on nuances of individual devices. Each manufacturer has recommendations for its specific device. There are also different indications for MCS, depending on patient urgency, and often, short-term MCS is emergently utilized. The focus of this document is long-term device therapy with the goal of patient discharge from the hospital.