Mechanical Circulatory Support for Right Ventricular Primary Graft Dysfunction After Heart Transplant: A Review

Primary graft dysfunction (PGD) is the most common cause of early mortality following heart transplantation. Although PGD can affect both ventricles, isolated right ventricular dysfunction (RV-PGD) is observed in nearly half of PGD patients. RV-PGD requires specific medical management to support the preload, afterload, and function of the failing RV; however, the use of mechanical circulatory support of the RV (RV-MCS) might be required when optimal medical therapy is insufficient in preventing forward failure and retrograde venous congestion. While RV-MCS options provide the opportunity to prevent or to recover from circulatory shock states, MCS is associated with a significant risk of complications. As a result of recent developments in short-term mechanical support devices, less invasive, percutaneous options for RV-MCS are available. In this review, we discuss the available devices, their advantages and disadvantages, and reported outcomes in RV-PGD.