Priority 17 from the Heart Surgery PSP

UNCERTAINTY: What is the best strategy for managing acute heart failure after heart surgery (inotropic drug, mechanical support or intravascular devices)? (JLA PSP Priority 17)
Overall ranking 17
JLA question ID 0088/17
Explanatory note Current guidelines contain recommendations focused on patients affected by heart failure, additional references can be identified among NICE and SIGN guidelines, society statements and systematic reviews.
Low quality evidence is available for preoperative beta-blockers therapy in heart failure prevention. Limited prospective randomized, multicentre data are available for mechanical circulatory support use, and there are concerns about their cost-effectiveness.
~ What is the optimal inotrope for support for coming off bypass in patients with right heart failure? Does the use of Impella / Intra-Aortic Balloon Pump (IABP) improve outcomes in patients after cardiac surgery with low cardiac output syndrome? 

Rihal CS, Naidu SS, Givertz MM, Szeto WY, Burke JA, Kapur NK, et al. 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care (Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie D'intervention). Catheter Cardiovasc Interv. 2015;85(7):E175-96; Sousa-Uva M, Head SJ, Milojevic M, Collet JP, Landoni G, Castella M, et al. 2017 EACTS Guidelines on perioperative medication in adult cardiac surgery. Eur J Cardiothorac Surg. 2018;53(1):5-33. 

Health Research Classification System category Cardiovascular
Extra information provided by this PSP
Original uncertainty examples What is the best inotrope for heart failure? ~ Intra-Aortic Balloon Pump (IABP) in patients after cardiac surgery with low cardiac output syndrome (LCOS); IMPELLA in patients after cardiac surgery with LCOS 
Submitted by 19 x healthcare professional, 2 others 
PSP information
PSP unique ID 0088
PSP name Heart Surgery
Total number of uncertainties identified by this PSP. 45  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 11 July 2019