Continuous-flow left ventricular assist device and the right ventricle

Left ventricular assist devices (LVADs) have become accepted as treatment for heart failure as a result of improvements in diagnosing and treating left ventricular failure and limited donor availability. In the Pivotal Study of the HeartMate II in the bridge to transplantation population, the incidence of right ventricular failure without the implantation of a right ventricular assist device was 14%, with an additional 6% of the participants ill enough that they required implantation of a right ventricular assist device. This complication increases mortality, cost, and length of stay. This article reviews the screening of LVAD candidates for the probability of right ventricular failure postoperatively, the evaluation of right ventricular function in LVAD candidates, and the optimal management of the right ventricle during the perioperative care of LVAD patients.