Right heart failure after durable left ventricular assist device implantation

ABSTRACT

Introduction

Right heart failure (RHF) is a well-known complication after left ventricular assist device (LVAD) implantation and portends increased morbidity and mortality. Understanding the mechanisms and predictors of RHF in this clinical setting may offer ideas for early identification and aggressive management to minimize poor outcomes. A variety of medical therapies and mechanical circulatory support options are currently available for the management of post-LVAD RHF.

Areas covered

We reviewed the existing definitions of RHF including its potential mechanisms in the context of durable LVAD implantation and currently available medical and device therapies. We performed a literature search using PubMed (from 2010 to 2023).

Expert opinion

RHF remains a common complication after LVAD implantation. However, existing knowledge gaps limit clinicians’ ability to adequately address its consequences. Early identification and management are crucial to reducing the risk of poor outcomes, but existing risk stratification tools perform poorly and have limited clinical applicability. This is an area ripe for investigation with the potential for major improvements in identification and targeted therapy in an effort to improve outcomes.

KEYWORDS:

• Durable LVAD
• right heart failure
• right ventricle
• mechanical circulatory support
• risk score

Article highlights

• The burden of post-LVAD RHF remains unacceptably high above 30% and portends significant morbidity and mortality.

• Early identification and diagnosis is crucial in reducing the morbidity and mortality of RHF in patients.

• The definition for post-LVAD RHF proposed by the mechanical circulatory support academic research consortium (MCS-ARC) is more comprehensive and considers various phenotypes of RHF.

• Current risk prediction models have limited clinical applicability and require further refinement and investigation.

• A number of medical and surgical therapies exist for RHF that can also be used to treat RHF after LVAD implantation, but more specific evidence-based therapies are needed.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.