Diagnosis and Management of Right-Sided Heart Failure in Subjects Supported With Left Ventricular Assist Devices

Abstract

Right ventricular failure (RVF) is a cause of major morbidity and mortality in the left ventricular assist device (LVAD) population. Many LVAD candidates have clinical or subclinical right ventricular (RV) dysfunction, and the perioperative period is fraught with insults that may provoke reactive pulmonary vascular hypertension and acute or chronic development of RVF. Thus, preoperative patient optimization using diuretics, pulmonary vasodilators, and inotropes to reduce RV wall stress and improve contractility is critical. An assessment of the LVAD candidate's risk for developing postoperative RVF is also key, especially in the destination therapy population for whom good options for long-term RV support currently are lacking. Intraoperatively, various pharmacologic and surgical interventions are available to reduce RVF risk. This review discusses RVF diagnosis and management strategies in subjects undergoing LVAD implantation.

Late-Onset Right Ventricular Failure in Patients With Preoperative Small Left Ventricle After Implantation of Continuous Flow Left Ventricular Assist Device

“…Concomitant TAP with LVAD implantation is also essential to avoid postoperative increases in RV preload because of worsening TR. 7 Consistently, TR did not worsen after CF LVAD implantation in 5 of 6 patients (83.3%) with late-onset RVF who received TAP perioperatively. Among 14 patients with late-onset RVF, postoperative tricuspid valve diameter in patients undergoing TAP was smaller than in those without TAP after CF LVAD implantation, though statistically insignificant (38.2±6.4 vs. 40.9±6.3 mm, P=0.115 by unpaired t-test).…”

Current and future applications of the intra-aortic balloon pump

“…Pre-existing right-ventricular dysfunction is a major predictor of the development of post-LVAD implantation right-ventricular failure, a complication associated with a dismal prognosis [38][39][40]. Consequently, patients presenting with rightventricular dysfunction are often considered ineligible for LVAD implantation.…”

Long-term use of the CentriMag® Ventricular Assist System as a right ventricular assist device: a case report

“…(Table 1) Simultaneous temporary CentriMag ® right ventricular assist device placement was planned due to the presence of multiple risk factors for RVF. 13,14 The HeartMate ® II device was implanted in the manner previously described, using cardiopulmonary bypass. 10 An Abiomed ® 32 Fr.…”