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Insertion, Maintenance, and Removal of the Percutaneous Dual Lumen Cannula Right Ventricular Assist Device
Published on: July 20, 2022
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Mechanical Circulatory Support for Right Ventricular Failure
Ersilia M DeFilippis1, Veli K Topkara1, Ajay J Kirtane1
1Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons New York, NY, US.
Cardiac Failure Review
|May 6, 2022
Summary
Right ventricular (RV) failure carries high mortality. This review covers mechanical circulatory support devices for RV failure, detailing indications, selection, strategies, and outcomes.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Right ventricular (RV) failure is a critical condition with high morbidity and mortality rates, often occurring post-cardiac surgery or due to specific conditions like myocardial infarction or pulmonary embolism.
- Medical management for RV failure includes fluid optimization and inotropic/vasopressor support, but some patients require advanced interventions.
- Persistent RV failure necessitates consideration of mechanical circulatory support (MCS) to improve outcomes.
Purpose of the Study:
- To review the current landscape of mechanical circulatory support devices for isolated right ventricular failure.
- To discuss the indications, patient selection criteria, and strategic implementation of various MCS devices.
- To evaluate the outcomes associated with different MCS strategies for RV failure.
Main Methods:
- This review synthesizes current literature on mechanical circulatory support for right ventricular failure.
- It examines percutaneous and surgical MCS options, including micro-axial flow pumps, extracorporeal centrifugal flow RV assist devices, surgically implanted RV assist devices, and veno-arterial extracorporeal membrane oxygenation.
- The review focuses on clinical applications, patient selection, procedural strategies, and patient outcomes.
Main Results:
- Right ventricular failure is associated with in-hospital mortality rates as high as 70-75%.
- Mechanical circulatory support is increasingly utilized for persistent RV failure, offering therapeutic options beyond medical management.
- Various percutaneous and surgical devices are available for isolated RV support, each with specific indications and potential benefits.
Conclusions:
- Mechanical circulatory support offers a vital therapeutic avenue for patients suffering from right ventricular failure.
- Appropriate patient selection, strategic device deployment, and careful management are crucial for optimizing outcomes in RV failure treated with MCS.
- Further research and technological advancements are expected to refine the use of MCS in managing RV failure.
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