Right Heart Failure Management: Focus on Mechanical Support Options

Bhatia, Meena; Jia, Shawn; Smeltz, Alan M.; Kumar, Priya A.

doi:10.1053/j.jvca.2022.02.022

Cited by 9 publications

(7 citation statements)

References 40 publications

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“…Another advantage of the UVAD is that speed and current signals can be used to indicate flow, making the pump a virtual flow meter, which would be useful for speed control. 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).…”

Section: Discussionmentioning

confidence: 99%

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

Karimov

Miyagi²,

Flick³

et al. 2023

Front. Cardiovasc. Med.

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ObjectiveSevere biventricular heart failure (BHF) can be remedied using a biventricular assist device (BVAD). Two devices are currently in development: a universal ventricular assist device (UVAD), which will be able to assist either the left, right, or both ventricles, and a continuous-flow total artificial heart (CFTAH), which replaces the entire heart. In this study, the in vitro hemodynamic performances of two UVADs are compared to a CFTAH acting as a BVAD.MethodsFor this experiment, a biventricular mock circulatory loop utilizes two pneumatic pumps (Abiomed AB5000™, Danvers, MA, USA), in conjunction with a dual-output driver, to create heart failure (HF) conditions (left, LHF; right, RHF; biventricular, BHF). Systolic BHF for four different situations were replicated. In each situation, CFTAH and UVAD devices were installed and operated at two distinct speeds, and cannulations for ventricular and atrial connections were evaluated.ResultsBoth CFTAH and UVAD setups achieved our recommended hemodynamic criteria. The dual-UVAD arrangement yielded a better atrial balance to alleviate LHF and RHF. For moderate and severe BHF scenarios, CFTAH and dual UVADs both created excellent atrial pressure balance. Conversely, when CFTAH was atrial cannulated for LHF and RHF, the needed atrial pressure balance was not met.ConclusionComprehensive in vitro testing of two different BVAD setups exhibited self-regulation and exceptional pump performance for both (single- and dual-device) BHF support scenarios. For treating moderate and severe BHF, UVAD and CFTAH both functioned well with respect to atrial pressure regulation and cardiac output. Though, the dual-UVAD setup yielded a better atrial pressure balance in all BHF testing scenarios.

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Section: Discussionmentioning

confidence: 99%

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

Karimov

Miyagi²,

Flick³

et al. 2023

Front. Cardiovasc. Med.

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“…They can be implanted either surgically or percutaneously and are approved for use for up to 4 weeks (but have been used for several months) while awaiting improvement of RV function or more definitive treatment [3]. Surgical RVADs are implanted via cannulation of the right atrium, and blood is returned to the pulmonary artery using an extracorporeal pump [15,40]. For patients with PAH, RVAD should not be used, as it may predispose the patient to pulmonary hemorrhage [40].…”

Section: Right Ventricular Assist Devices (Rvads)mentioning

confidence: 99%

Approach to Decompensated Right Heart Failure in the Acute Setting

Levitt,

Williams,

Ahari

et al. 2024

JCM

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Acute right heart failure (ARHF) arises when the right ventricle fails to pump blood efficiently to the pulmonary circulation. This inefficiency leads to a decreased blood supply to various organs. ARHF is a significant health concern, often leading to increased hospital admissions and being associated with a higher risk of mortality. This condition underscores the importance of effective cardiac care and timely intervention to manage its complications and improve patient outcomes. Diagnosing ARHF involves a comprehensive approach that includes a physical examination to evaluate the patient’s fluid status and heart-lung function, blood tests to identify potential triggers and help forecast patient outcomes and various imaging techniques. These imaging techniques include electrocardiograms, point-of-care ultrasounds, computed tomography, cardiac magnetic resonance imaging, and other advanced monitoring methods. These diagnostic tools collectively aid in a detailed assessment of the patient’s cardiac and pulmonary health, essential for effective management of ARHF. The management of ARHF focuses on addressing the underlying causes, regulating fluid balance, and enhancing cardiac function through pharmacological treatments or mechanical support aimed at boosting right heart performance. This management strategy includes the use of medications that modulate preload, afterload, and inotropy; vasopressors; anti-arrhythmic drugs; ensuring proper oxygenation and ventilation; and the utilization of heart and lung assist devices as a bridge to potential transplantation. This review article is dedicated to exploring the pathophysiology of ARHF, examining its associated morbidity and mortality, evaluating the various diagnostic tools available, and discussing the diverse treatment modalities. The article seeks to provide a comprehensive understanding of ARHF, its impact on health, and the current strategies for its management.

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“…Blood drawn from the RA is returned to the PA using an extracorporeal pump. 12 Indications for this treatment are post-transplant, post LVAD implantation, or post cardiac surgery due to cardiogenic shock. Therefore, when there is hemodynamic instability, with CI < 2 L/ min, systemic hypotension, PVC >15, acute oliguric renal failure and echocardiographic evidence of severe right ventricular disfunction, mechanical therapy becomes the benchmark.…”

Section: Mechanical Treatment Of Rvfmentioning

confidence: 99%

Intraoperative prophylactic right ventricular assist device in prevention of postcardiotomy failure

et al. 2023

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Objectives In patients at risk of developing right ventricular failure after cardiac surgery, right ventricular support with a ventricular assist device may be a promising strategy to reduce mortality. We present our experience with intraoperative right ventricular assist device implantation as a prevention strategy of right ventricular failure after cardiac surgery. Methods Between 2016 and 2022, we implanted four right ventricular assist devices prophylactically in a series of patients with surgical indication for valvular heart disease and high risk of postoperative right ventricular failure. Indications for the right ventricular assist device were suprasystemic pulmonary hypertension or severe right ventricular dysfunction. Results Externalization of the device cannulas through intercostal spaces was performed in three patients, allowing early mobilization and withdrawal without resternotomy. Removal of the device ocurred on the eighth postoperative day. ICU and hospital length of stay was 12 (±1.6) and 23 days (±4.2) respectively. Hospital mortality was null. No patient died during follow-up, mean follow-up was 32.5 months [1–72]. Patients improved their NYHA functional class up to grade II during follow-up. Conclusions Acute right ventricular failure after cardiac surgery remains a significant cause of morbidity and mortality. Prophylactic strategies to prevent postoperative right ventricular dysfunction may decrease the incidence of refractory postoperative right ventricular failure. We propose a novel approach to prevent right failure after cardiac surgery with prophylactic intraoperative ventricular assist device implantation.

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Right Heart Failure Management: Focus on Mechanical Support Options

Cited by 9 publications

References 40 publications

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

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

Approach to Decompensated Right Heart Failure in the Acute Setting

Intraoperative prophylactic right ventricular assist device in prevention of postcardiotomy failure

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