Right Ventricular Failure After Left Ventricular Assist Device Implantation:  The Need for an Implantable Right Ventricular Assist Device

Abstract

Right ventricular failure after implantation of a left ventricular assist device is an unremitting problem. Consideration of portal circulation is important for reversing liver dysfunction and preventing multiple organ failure after left ventricular assist device implantation. To achieve these objectives, it is imperative to maintain the central venous pressure as low as possible. A more positive application of right ventricular assistance is recommended. Implantable pulsatile left ventricular assist devices cannot be used as a right ventricular assist device because of their structure and device size. To improve future prospects, it is necessary to develop an implantable right ventricular assist device based on a rotary blood pump.

Effects of the HeartMate II continuous-flow left ventricular assist device on right ventricular function

“…7 Moreover, most of these studies were done in patients who received pulsatile pumps rather than those in the current era in which continuous-flow pumps are being predominantly used, which might limit the usefulness and relevance of those studies. 7,8 Although the benefits of continuous-flow pumps on LV unloading and end-organ function have been well documented, the complex interactions of continuous-flow physiology on RV function and performance are less well known. Recently, changes in RV function during support with a centrifugal pump have been shown not to worsen during intermediate-term follow-up.…”

Right Ventricular Failure—A Continuing Problem in Patients with Left Ventricular Assist Device Support

“…Unfortunately, the complex pathophysiology of RV failure, which could potentially be related to RV myocardial dysfunction, interventricular dependence, and RV afterload has led to inconsistencies in predicting risk factors for RV dysfunction [13]. Moreover, the majority of these studies were done using pulsatile pumps as opposed to the current era in which continuous-flow pumps are being predominantly used, which might limit usefulness and relevance of those studies [13,14].…”

Management of Pulmonary Hypertension and Right Heart Failure in the Intensive Care Unit

“…Right ventricular assist devices (RVAD) in the form of centrifugal pumps can be surgically implanted (CentriMag, Thoratec Corporation, Pleasanton, CA) or percutaneously inserted (TandemHeart, Cardiac Assist, Pittsburg, PA) with or without an oxygenator and divert blood from the vena cava or right atrium to the pulmonary artery or left atrium, effectively bypassing the right ventricle. Right ventricular assist devices have been successfully used in patients with RV failure following right ventricular infarct, postcartiotomy shock, cardiac transplantation, and left ventricular assist device implantation [68][69][70][71].…”