End-of-Life Planning in Patients with Mechanical Circulatory Support

In summary, the growing uses of MCS in patients with advanced heart failure have brought about an increased need to address end-of-life management, from advance care planning with MCS device withdrawal. Although many patients are successfully bridged with temporary MCS to more definitive management such as cardiac recov-ery, transplantation, or durable MCS device, some patients will die after withdrawal of temporary MCS, and those with durable MCS, particularly as DT, will eventually face end-of-life device management. Preparedness planning before MCS initiation can lay the groundwork for smooth transitions to end of life. Palliative care services also play an important role in exploring patients' goals of care to ensure patient-centered out-comes and can assist clinicians in supporting surrogate decision-makers and care-givers. Ethical dilemmas, including different views on withdrawal/deactivation, different aspects of futility, and resource utilization, can all complicate end-of-life care. Finally, withdrawal/deactivation should follow a set protocol that addresses psy-chosocial/spiritual needs as well as patient comfort.