Right heart failure after left ventricular assist device implantation: early and late

To review recent publications on right heart failure developing early and late after implantation of left ventricular assist devices (LVAD).

Whereas use of the newer continuous flow devices is associated with improved outcomes, right heart failure remains a considerable challenge. Recent studies have provided good evidence about predicting right heart failure early after LVADs, though how to predict right heart failure late after LVAD is still unclear as most studies in this area are small single centre experience studies. With respect to medical therapies for treating right heart failure, there is evidence for the use of both nitric oxide and the phosphodiesterase type 5 inhibitor sildenafil in carefully selected patients with secondary pulmonary hypertension who undergo implantation of LVADs.

Despite improved outcomes, right heart failure remains a significant challenge to selecting and managing patients with LVADs, though we do have clearer evidence now for predicting early right heart failure, and treating it in those patients with secondary pulmonary hypertension.