Mechanical Circulatory Support Devices for Acute Right Ventricular Failure

Abstract

Right ventricular (RV) failure remains a major cause of global morbidity and mortality for patients with advanced heart failure, pulmonary hypertension, or acute myocardial infarction and after major cardiac surgery. Over the past 2 decades, percutaneously delivered acute mechanical circulatory support pumps specifically designed to support RV failure have been introduced into clinical practice. RV acute mechanical circulatory support now represents an important step in the management of RV failure and provides an opportunity to rapidly stabilize patients with cardiogenic shock involving the RV. As experience with RV devices grows, their role as mechanical therapies for RV failure will depend less on the technical ability to place the device and more on improved algorithms for identifying RV failure, patient monitoring, and weaning protocols for both isolated RV failure and biventricular failure. In this review, we discuss the pathophysiology of acute RV failure and both the mechanism of action and clinical data exploring the utility of existing RV acute mechanical circulatory support devices.

Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology

“…Furthermore, pumping blood out of the left atrium depends on preload to the left ventricle. TandemHeart can be easily configured to a right ventricular support system (TandemHeart RVAD) …”

“…TandemHeart can be easily configured to a right ventricular support system (TandemHeart RVAD). 188 Other contraindications include significant peripheral vascular disease, general contraindications for anticoagulation therapy, presence of right or left atrial thrombi, ventricular septal defect, or severe aortic insufficiency. Anticoagulation therapy is mandatory due to the high risk of thromboembolic events.…”

SCAI clinical expert consensus statement on the classification of cardiogenic shock

“…Pulmonary artery (PA) catheters can directly measure right atrial (RA), PA and pulmonary capillary wedge pressures (PCWP), mixed venous oxygenation, cardiac output (CO) and allows calculation of CI, systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), pulmonary artery pulsatility index (PAPI), and cardiac power output (CPO). Recent reviews of the hemodynamics of CS provide further details on the derived values and interpretation of these indices in this setting …”

Pulmonary artery pulsatility index: physiological basis and clinical application

“…The PAPi is a relatively recent addition to the list of measures of right heart function, but has already been advocated in the assessment of the right heart in clinical practice. 8 The PAPi is calculated as the PAPP divided by the right atrial or central venous pressure:…”