Right ventricular failure after left ventricular assist device implantation: a review of the literature

Abstract

Right ventricular failure (RVF) following left ventricular assist device (LVAD) implantation remains a major complication which may significantly impair patient outcome. The genesis of RVF is, however, multifactorial, and the mechanisms underlying such a condition have not been fully elucidated, making its prevention challenging and the course not always predictable. Although preoperative risks factors can be associated with RV impairment, the physiologic changes after the LV support, can still hamper the function of the RV. Current medical treatment options are limited and sometimes, patients with a severe post-LVAD RVF may be unresponsive to pharmacological therapy and require more aggressive treatment, such as temporary RV support. We retrieved 11 publications which we assessed and divided in groups based on the RV support [extracorporeal membrane oxygenation (ECMO), right ventricular assist device (RVAD), TandemHeart with ProtekDuo cannula]. The current review comprehensively summarizes the main studies of the literature with particular attention to the RV physiology and its changes after the LVAD implantation, the predictors and prognostic score as well as the different modalities of temporary mechanical cardiocirculatory support, and its effects on patient prognosis for RVF in such a setting. In addition, it provides a decision making of the pre-, intra and post-operative management in high-and moderate-risk patients.

Primary results of long‐term outcomes in the MOMENTUM 3 pivotal trial and continued access protocol study phase: a study of 2200 HeartMate 3 left ventricular assist device implants

“…Our multivariable analysis demonstrates that this reflects the sicker population enrolled and greater preponderance of transplant ineligible patients, a population likely to experience earlier haemodynamic instability 23,24 . It is not easy to predict the need for RVAD support using haemodynamic parameters or other metabolic indices and the clearest risk for such use is based on the overall clinical severity at time of implantation 25 …”

“… 23 , 24 It is not easy to predict the need for RVAD support using haemodynamic parameters or other metabolic indices and the clearest risk for such use is based on the overall clinical severity at time of implantation. 25 …”

When Nothing Goes Right: Risk Factors and Biomarkers of Right Heart Failure after Left Ventricular Assist Device Implantation

“…However, these patients remain at risk for developing late RHF during LVAD support, which is an important concern, particularly in destination therapy (DT) but also in bridge to transplantation (BTT) or bridge to candidacy (BTC) patients with a long estimated duration of LVAD support. Many models of RHF post-LVAD implantation use preoperative risk factors [ 6 ] such as tricuspid regurgitation or elevated central venous pressure (CVP) [ 7 , 8 ], while others describe biomarkers of intrinsic RV function such as elevated blood urea levels as independent risk factors [ 9 ]. On the other hand, a less invasive surgical implantation strategy has been suggested to have a protective effect on the development of RHF after LVAD implantation [ 10 ].…”

Left ventricular assist devices and right ventricular failure prediction: Quo Vadis?

“…Severe RVF requiring the implant of a right ventricular assist device is associated with a survival which may be as low as 58% at 1 year and 31% at 5 years [ 1–3 ]. Based on these data, both scientific and clinical communities have invested efforts to describe, define, predict, prevent and treat post-LVAD RVF [ 4 ]. Nevertheless, the overall RVF dilemma is still unsolved.…”