Right ventricular failure during clinical use of a left ventricular assist device

The purpose of this study is to describe the authors' clinical experience of RVF during LVAD pumping and to delineate the effect of LVADs on RV function, with special reference to the level of myocardial recovery. Pneumatically driven LVADs were used on a total of 13 postoperative cases for 18 hours to 70 days (mean, 9.9 days). The RVF, which was defined as increased right atrial pressure (RAP greater than or equal to 20 mmHg) during LVAD pumping, were experienced in four cases (two ischemic, two valvular). Duration of the RVF ranged from 3 hours to 8 days (mean, 3.0 days) and the maximum RAP ranged 22-30 mmHg (mean, 27 mmHg). The effects of LVAD pumping on the RV function were delineated during serial pump on-pump off studies in two cases with RVF and three cases without RVF, in relation to off/on ratio of the systolic aortic pressure (AOP off/on), which worked as an indicative parameter of myocardial recovery. Each pair of on/off data were assigned to four groups according to AOP off/on and complication with RVF, and mean percentage changes of mRAP and PAP were compared. The RAP of RVF cases were significantly increased by 16% with the LVAD pumping when the AOP off/on was below 0.7, whereas PAP invariably decreased in most cases. The results indicated that the LVAD suppressed the RV function before the myocardial recovery and when the heart was complicated with RVF.