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Mechanical Circulatory Support for Right Ventricular Primary Graft Dysfunction After Heart Transplant: A Review
Einar A Hart1, S A Braithwaite2, J A J Hermens3
1Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands.
Clinical Transplantation
|December 31, 2024
Summary
Primary graft dysfunction (PGD) is a major cause of death after heart transplants. Isolated right ventricular dysfunction (RV-PGD) may require mechanical circulatory support (RV-MCS) when medical therapy fails.
Area of Science:
- Cardiology
- Transplantation Medicine
- Critical Care Medicine
Background:
- Primary graft dysfunction (PGD) is the leading cause of early mortality after heart transplantation.
- Isolated right ventricular dysfunction (RV-PGD) occurs in approximately half of PGD cases.
- RV-PGD necessitates tailored management to support the failing right ventricle.
Purpose of the Study:
- To review current mechanical circulatory support (MCS) options for right ventricular PGD (RV-PGD).
- To discuss the advantages, disadvantages, and outcomes of available RV-MCS devices.
- To highlight recent advancements in less invasive, percutaneous RV-MCS technologies.
Main Methods:
- Literature review of studies on RV-PGD and RV-MCS.
- Analysis of device-specific characteristics, including invasiveness and application.
- Synthesis of reported outcomes and complication rates associated with RV-MCS.
Main Results:
- Optimal medical therapy may be insufficient for RV-PGD, necessitating RV-MCS.
- RV-MCS options offer support but carry significant complication risks.
- Emerging percutaneous devices provide less invasive RV support options.
Conclusions:
- RV-MCS is a critical intervention for refractory RV-PGD.
- Careful selection of RV-MCS devices is essential to balance efficacy and complications.
- Advancements in percutaneous technology are expanding treatment possibilities for RV-PGD.
