Mechanical circulatory support for the right ventricle in the setting of a left ventricular assist device

Abstract

Right ventricular failure is a difficult problem to manage and typically carries a dismal prognosis. In the setting of post-left ventricular assist device implantation (LVAD), right ventricular dysfunction both in the early and late stages is of particularly high incidence and concern. There are currently no agreed upon preoperative algorithms to predict patients at risk for this problem, thus adding another level of complexity to treatment. Furthermore, there is no current technology available for chronic right ventricular support and the devices currently in use are LVADS modified to adapt to the right circulatory system. This review provides an overview of right ventricular failure, particularly after LVAD implantation, and describes the survival outcomes and continued challenges in this area.

Keywords::

• heart failure
• mechanical circulatory support
• right ventricular failure
• right ventricular recovery
• ventricular assist devices

Financial & competing interests disclosure

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.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Right ventricular heart failure is a difficult process to treat and manage and carries with it a poor prognosis.

• RV failure after left ventricular assist device implantation is particularly common and even more difficult than isolated RV failure.

• The ability to predict patients at risk of RV failure following left ventricular assist device implantation is an area that has no complete answer but likely involves multiple factors, including clinical data, laboratory values and echocardiography findings.

• There are various devices available for the management of right heart failure, some of which are temporary and some of which are more long term or permanent.

• There continues to be development of new devices, but there is yet to be a successful dedicated device to manage the load and dynamics of the right ventricle.

• The successful recovery of the right ventricle following left ventricular assist device insertion is variable and better if one can predict and treat with a concomitant RV device, but still poor.

• There is a need for larger, more in-depth studies to evaluate not only an algorithm to predict which patients benefit from RVADs but also which current device may be best.