Prediction of Right Heart Failure After Left Ventricular Assist Device: Opening Pandora's Box

Area of Science:

• Cardiology
• Medical Devices
• Heart Failure Management

Background:

• Left ventricular assist devices (LVADs) are crucial for end-stage heart failure (HF).
• Adequate right ventricular (RV) function is essential for successful LVAD outcomes.
• Early right heart failure (RHF) post-LVAD significantly increases mortality and morbidity.

Purpose of the Study:

• To address the challenges in preoperative RV assessment for LVAD candidates.
• To propose a comprehensive and adaptable RV appraisal strategy.
• To optimize patient selection and improve post-LVAD outcomes.

Main Methods:

• Review of diagnostic modalities for RV function evaluation (clinical assessment, echocardiography, RHC, risk models).
• Analysis of advantages and limitations of each diagnostic tool and parameter.
• Development of a preoperative RV assessment strategy tailored to patient hemodynamic status (critical vs. stable).

Main Results:

• Current RV assessment methods have variable predictive power and limitations.
• ECMO support complicates RV assessment due to complete right heart unloading.
• A multimodal, adaptable strategy is proposed to overcome current assessment challenges.

Conclusions:

• Preoperative RV assessment is critical but challenging, especially in unstable patients.
• The proposed strategy integrates various diagnostic tools for a comprehensive RV evaluation.
• Optimized RV assessment can mitigate RHF risk and improve LVAD therapy efficacy.