Perioperative Mechanical Circulatory Support for Cardiac Assistance in Thoracic Surgery: A Scoping Review Protocol

Background and Aims

Over the past decades, the number of cardiac patients (e.g., with advanced heart failure or existing cardiovascular comorbidities that expose them to a heightened risk of acute cardiovascular decompensation) requiring noncardiac surgery is rising. For this patient population, potentially curative surgical treatments may be denied due to their prohibitive perioperative risk. Around 30% of patients undergoing general thoracic surgery experience cardiovascular complications of varying severity that may ultimately result in refractory heart failure and/or hemodynamic instability. In both these scenarios, perioperative implantation of temporary mechanical circulatory support (tMCS) may improve patient outcomes by both expanding preoperative surgical eligibility criteria and enabling safer management of unexpected periprocedural complications. This scoping review seeks to summarize the current existing evidence on the role of tMCS for cardiac assistance in thoracic surgery and provide a thorough overview.

Methods

We will perform a scoping review adhering to the Joanna Briggs Institute (JBI) methodology and the extension for Scoping Reviews of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist (PRISMA). We will carry out a comprehensive search of several online databases to identify studies on the perioperative implantation of tMCS in patients undergoing thoracic surgery to provide cardiac assistance either due to their heightened preoperative cardiac risk (pre-emptive tMCS) or for acute cardiac failure due to inherent surgical complications (bail-out tMCS). Standardized forms will be employed to perform data charting and extraction.

Results

Retrieved studies will be presented through a narrative synthesis following initial categorization, supplemented by descriptive statistical analyses of quantitative data if adequate inter-study homogeneity is observed and further complemented by figures and tables.

Conclusion

The planned scoping review aims to assess the safety and feasibility of perioperative implantation of tMCS in patients undergoing thoracic surgery either to mitigate their heightened cardiovascular risk or as a rescue strategy in the event of life-threatening surgical complications. It will identify knowledge gaps, offer direction for future research, and improve clinical practices within the field.