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Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
Right ventricular failure--a continuing problem in patients with left ventricular assist device support
Ranjit John1, Sangjin Lee, Peter Eckman
1Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN 55455, USA. johnx008@umn.edu
Journal of Cardiovascular Translational Research
|September 3, 2010
Summary
Right ventricular (RV) failure is a significant complication after left ventricular assist device (LVAD) implantation. Current strategies and continuous-flow physiology show promise in reducing RV failure incidence in heart failure patients.
Area of Science:
- Cardiology
- Mechanical Circulatory Support
- Heart Failure Research
Background:
- Limited donor hearts necessitate advanced therapies like left ventricular assist devices (LVADs) for heart failure patients awaiting transplant.
- Right ventricular (RV) failure is a critical complication post-LVAD implantation, increasing morbidity and mortality.
- Predicting and preventing RV failure is challenging due to complex pathophysiology, including myocardial dysfunction and interventricular dependence.
Purpose of the Study:
- To review the challenges and evolving strategies in managing and preventing right ventricular failure following left ventricular assist device implantation.
- To identify patient groups requiring biventricular support and understand risk factors for RV dysfunction.
- To assess the impact of current trends in mechanical circulatory support on RV failure incidence.
Main Methods:
- Review of existing literature and clinical experience with left ventricular assist devices and right ventricular failure.
- Analysis of evolving strategies aimed at avoiding or reducing RV failure.
- Examination of risk factors and predictive scoring systems for RV dysfunction.
- Evaluation of the relationship between RV unloading, function, and continuous-flow physiology.
Main Results:
- Right ventricular failure remains a significant cause of morbidity and mortality after LVAD implantation.
- Despite numerous identified risk factors and predictive scores, consistently identifying patients at risk for RV failure remains challenging.
- A lower incidence of RV failure in the current era suggests improved outcomes, potentially linked to RV unloading and continuous-flow technology.
Conclusions:
- Effective identification of patients needing biventricular support is crucial.
- Evolving strategies and advancements in continuous-flow LVADs appear to be favorably impacting RV function and reducing failure rates.
- Further research into the complex pathophysiology of RV failure is necessary to refine management and prevention strategies.
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