In 2013, the International Society for Heart and Lung Transplantation (ISHLT) published the first official guidelines for implantable mechanical circulatory support (MCS) as commissioned by its Board of Directory. Considering the substantial growth and technological advancement in the MCS field, much of the content of the 2013 report is no longer clinically relevant and new information is needed. In response to this and at the request of the Board of Directors to keep ISHLT guidelines appropriately updated, the MCS Council approved and commissioned the development of a focused update. The 2013 MCS guidelines were organized into individual Task Forces covering preoperative, intraoperative, and postoperative management of MCS patients. These guidelines exclusively pertain to patients treated with implantable left ventricular assist devices (LVADs). In addition to updating and augmenting this content, the 2023 Guidelines update includes 4 additional Task Forces resulting in the most comprehensive resource guiding the management of patients with durable mechanical circulatory support (DMCS). As the field of MCS has evolved, these guidelines now pertain to all configurations of DMCS including single and biventricular support.

During the development of this document some notable changes occurred that are relevant to the field. Most significantly, the HeartMate III was introduced into practice; and following a successful clinical trial, it was approved for use in both the USA and Europe. As a result, the HeartMate II pump was rapidly phased out of clinical practice. More recently, Medtronic discontinued new implants of the HVAD. As there are a significant number of HVAD and HMII supported patients still in clinical practice, these guidelines remain pertinent and continue to guide the management of patients supported with these pumps. Eight years after the original guidelines were published, the Centers for Medicare and Medicaid Services redefined the categories for the approval of LVADs replacing the traditional bridge-to-transplant and Destination Therapy terminology. The traditional terminology remains widely used worldwide and as such continues to be used in these updated guidelines. Also, of note, these guidelines are intended to specifically guide the management of DMCS patients. Notably absent are utilization and management guidelines for temporary mechanical support, as these guidelines are forthcoming.

The terminology used in this guidelines-update is important and should be considered by the reader. As the new guidelines include additional implantable devices, we have substituted DMCS for implantable MCS and LVAD throughout the document. This term is used when a statement or recommendation is applicable broadly to all durable heart pumps and configurations. More specific terms such as LVAD, BIVAD, or TAH are used when a statement or recommendation is specific to a device or configuration. Writers were encouraged to use DMCS whenever possible.