Mechanical circulatory support devices and treatment strategies for right heart failure

Abstract

The importance of right heart failure (RHF) treatment is magnified over the years due to the increased risk of mortality. Additionally, the multifactorial origin and pathophysiological mechanisms of RHF render this clinical condition and the choices for appropriate therapeutic target strategies remain to be complex. The recent change in the United Network for Organ Sharing (UNOS) allocation criteria of heart transplant may have impacted for the number of left ventricular assist devices (LVADs), but LVADs still have been widely used to treat advanced heart failure, and 4.1 to 7.4% of LVAD patients require a right ventricular assist device (RVAD). In addition, patients admitted with primary left ventricular failure often need right ventricular support. Thus, there is unmet need for temporary or long-term support RVAD implantation exists. In RHF treatment with mechanical circulatory support (MCS) devices, the timing of the intervention and prediction of duration of the support play a major role in successful treatment and outcomes. In this review, we attempt to describe the prevalence and pathophysiological mechanisms of RHF origin, and provide an overview of existing treatment options, strategy and device choices for MCS treatment for RHF.

Biventricular circulatory support using single-device and dual-device configurations: Initial pump characterization in simulated heart failure model

“…The functional anatomy and pathogenesis of RV and LV failure is closely interconnected and either of these conditions affect the prognosis for the other (5,22,26,27). Thus, the communication between circulatory assist devices is imperative for a successful operation in biventricular support (28). This is deemed possible only if identical device architecture and control interface is employed (25).…”

Extracorporeal Membrane Oxygenation for Respiratory Failure: A Narrative Review

“…V-P ECMO may be accomplished as a two-cannula strategy, with drainage cannula in the intrahepatic IVC and single lumen return cannula in the main pulmonary artery, or as a single, dual-lumen cannula (e.g., ProtekDuo) (Figure 1). In patients with acute cor pulmonale, V-P ECMO has been shown to improve RV function, decrease vasoactive inotropic score, and improve oxygenation in patients with ARDS, likely by eliminating recirculation and uncoupling the dependence of oxygen delivery (DO2) on RV function [9][10][11][12]. V-P ECMO as an optimal configuration strategy, though, deserves further research to evaluate patient outcomes.…”

Mechanical Circulatory Support Devices in Patients with High-Risk Pulmonary Embolism

“…Additionally, the device can also be connected to an oxygenator, providing reversal of hypoxia and reducing the associated vasoconstriction and elevated peripheral vascular resistance (PVR). European Medicines Agency has approved the LifeSPARC Pump and ProtekDuo cannula for 30-day support and the FDA for 6-day support [ 51 , 52 ].…”