Prediction, prevention, and management of right ventricular failure after left ventricular assist device implantation: A comprehensive review

Abstract

Left ventricular assist devices (LVADs) are increasingly common across the heart failure population. Right ventricular failure (RVF) is a feared complication that can occur in the early post-operative phase or during the outpatient follow-up. Multiple tools are available to the clinician to carefully estimate the individual risk of developing RVF after LVAD implantation. This review will provide a comprehensive overview of available tools for RVF prognostication, including patient-specific and right ventricle (RV)-specific echocardiographic and hemodynamic parameters, to provide guidance in patient selection during LVAD candidacy. We also offer a multidisciplinary approach to the management of early RVF, including indications and management of right ventricular assist devices in this setting to provide tools that help managing the failing RV.

Left ventricular assist device implantation and concomitant mitral valve surgery: A systematic review and meta‐analysis

“…Furthermore, several included studies 35,36 investigating need for RVAD postoperatively reported longer time spent upon cardiopulmonary bypass with concomitant MV repair or replacement alongside need for cross‐clamping of the aorta. Hence, resultant ischaemic‐reperfusion injury impairing right ventricular function in the short term 37 may offset any benefit to right ventricular function provided by elimination of residual MR in patients receiving MV repair or replacement which may be reflected by the lack of reduced need for RVAD therapy in these patients. Moreover, development of post‐operative right heart failure necessitating RVAD therapy is highly multifactorial and is, for example, influenced by baseline illness severity and presence of comorbidities 38 .…”

How to Select Patients for Left Ventricular Assist Devices? A Guide for Clinical Practice

“…Right ventricle evaluation : Most echocardiography-based predictors of right ventricular failure (RVF) post-LVAD implantation are based on assessing RV systolic–diastolic function. However, it was recently demonstrated that evaluating the RV–pulmonary artery (PA) parameters may increase the possibility of predicting postimplant RVF [ 42 ]. A systolic tricuspid annulus plane excursion (TAPSE) of <8 mm has been associated with RVF [ 43 , 44 ]; similarly, a right ventricular free wall s′ value on tissue Doppler of <5–8 cm/s [ 45 ] and an RV fractional area change (FAC) value of <25–30% [ 45 ] are associated with postimplant RVF.…”

Right Ventricular Assist Device Placement During Left Ventricular Assist Device Implantation Is Associated With Improved Survival

“…Historically, right ventricular failure (RVF) following durable left ventricular assist device (LVAD) implantation represents a significant cause of morbidity and mortality and reduced transplantation rates. [1][2][3][4] As the field of mechanical circulatory support (MCS) continues to evolve, there have been numerous strategies focusing on predicting RV failure, particularly following LVAD implantation. These include invasive hemodynamic risk indices such as the pulmonary artery pulsatility index (PAPi), [5][6][7] central venous/pulmonary capillary wedge pressure ratio, 8 RV echocardiographic strain, 9 tricuspid annular plane systolic excursion (TAPSE), 10 RV fractional area change, 11 tissue Doppler imaging of the RV free wall 12 and RV myocardial performance index.…”