Prediction, Prevention, and Management of Right Ventricular Failure After Left Ventricular Assist Device Implantation: A Comprehensive Review

Overview

Journal Front Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2022 Nov 21

PMID 36407460

Authors

Eduard Rodenas-Alesina

Darshan H Brahmbhatt

Vivek Rao

Marcus Salvatori

Filio Billia

Affiliations

Soon will be listed here.

Abstract

Left ventricular assist devices (LVADs) are increasingly common across the heart failure population. Right ventricular failure (RVF) is a feared complication that can occur in the early post-operative phase or during the outpatient follow-up. Multiple tools are available to the clinician to carefully estimate the individual risk of developing RVF after LVAD implantation. This review will provide a comprehensive overview of available tools for RVF prognostication, including patient-specific and right ventricle (RV)-specific echocardiographic and hemodynamic parameters, to provide guidance in patient selection during LVAD candidacy. We also offer a multidisciplinary approach to the management of early RVF, including indications and management of right ventricular assist devices in this setting to provide tools that help managing the failing RV.

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References

Thongprayoon C, Lertjitbanjong P, Cheungpasitporn W, Hansrivijit P, Fulop T, Kovvuru K . Incidence and impact of acute kidney injury on patients with implantable left ventricular assist devices: a Meta-analysis. Ren Fail. 2020; 42(1):495-512. PMC: 7301695. DOI: 10.1080/0886022X.2020.1768116. View

Anwer L, Tchantchaleishvili V, Poddi S, Daly R, Joyce L, Kushwaha S . Atrial Fibrillation Should Guide Prophylactic Tricuspid Procedures During Left Ventricular Assist Device Implantation. ASAIO J. 2017; 64(5):586-593. DOI: 10.1097/MAT.0000000000000698. View

Song H, Gelow J, Mudd J, Chien C, Tibayan F, Hollifield K . Limited Utility of Tricuspid Valve Repair at the Time of Left Ventricular Assist Device Implantation. Ann Thorac Surg. 2016; 101(6):2168-74. PMC: 4877201. DOI: 10.1016/j.athoracsur.2016.03.040. View

Alnsasra H, Asleh R, Schettle S, Pereira N, Frantz R, Edwards B . Diastolic Pulmonary Gradient as a Predictor of Right Ventricular Failure After Left Ventricular Assist Device Implantation. J Am Heart Assoc. 2019; 8(16):e012073. PMC: 6759881. DOI: 10.1161/JAHA.119.012073. View

Grandin E, Troutman G, Gulati A, Zamani P, Mazurek J, Atluri P . A Modified Grading System for Early Right Heart Failure Matches Functional Outcomes and Survival After Left Ventricular Assist Devices. ASAIO J. 2020; 67(2):185-191. DOI: 10.1097/MAT.0000000000001203. View

Tsuji M, Amiya E, Bujo C, Hara T, Saito A, Minatsuki S . Carbon Monoxide Diffusing Capacity Predicts Cardiac Readmission in Patients Undergoing Left Ventricular Assist Device Implantation in Japan. ASAIO J. 2021; 67(10):1111-1118. DOI: 10.1097/MAT.0000000000001363. View

Kasinpila P, Kong S, Fong R, Shad R, Kaiser A, Marsden A . Use of patient-specific computational models for optimization of aortic insufficiency after implantation of left ventricular assist device. J Thorac Cardiovasc Surg. 2020; 162(5):1556-1563. PMC: 7666659. DOI: 10.1016/j.jtcvs.2020.04.164. View

Sparrow C, Nassif M, Raymer D, Novak E, LaRue S, Schilling J . Pre-Operative Right Ventricular Dysfunction Is Associated With Gastrointestinal Bleeding in Patients Supported With Continuous-Flow Left Ventricular Assist Devices. JACC Heart Fail. 2015; 3(12):956-64. DOI: 10.1016/j.jchf.2015.09.009. View

McGiffin D, Kure C, McLean J, Marasco S, Bergin P, Hare J . The results of a single-center experience with HeartMate 3 in a biventricular configuration. J Heart Lung Transplant. 2021; 40(3):193-200. DOI: 10.1016/j.healun.2020.12.006. View

10.

Badu B, Durham 3rd L, Joyce L, Joyce D . Iatrogenic superior vena cava syndrome from percutaneous right ventricular assist device. JTCVS Tech. 2021; 6:92-94. PMC: 8300479. DOI: 10.1016/j.xjtc.2020.11.013. View

11.

Uriel N, Burkhoff D, Rich J, Drakos S, Teuteberg J, Imamura T . Impact of Hemodynamic Ramp Test-Guided HVAD Speed and Medication Adjustments on Clinical Outcomes. Circ Heart Fail. 2019; 12(4):e006067. DOI: 10.1161/CIRCHEARTFAILURE.119.006067. View

12.

Tanaka Y, Nakajima T, Fischer I, Wan F, Kotkar K, Moon M . The impact of uncorrected mild aortic insufficiency at the time of left ventricular assist device implantation. J Thorac Cardiovasc Surg. 2020; 160(6):1490-1500.e3. DOI: 10.1016/j.jtcvs.2020.02.144. View

13.

Kanwar M, Selzman C, Ton V, Miera O, Cornwell 3rd W, Antaki J . Clinical myocardial recovery in advanced heart failure with long term left ventricular assist device support. J Heart Lung Transplant. 2022; 41(10):1324-1334. PMC: 10257189. DOI: 10.1016/j.healun.2022.05.015. View

14.

Cholley B, Caruba T, Grosjean S, Amour J, Ouattara A, Villacorta J . Effect of Levosimendan on Low Cardiac Output Syndrome in Patients With Low Ejection Fraction Undergoing Coronary Artery Bypass Grafting With Cardiopulmonary Bypass: The LICORN Randomized Clinical Trial. JAMA. 2017; 318(6):548-556. PMC: 5817482. DOI: 10.1001/jama.2017.9973. View

15.

Unger E, Sweis R, Bharat A . Unusual Complication of a Right Ventricular Support-Extracorporeal Membrane Oxygenation Cannula. JAMA Cardiol. 2021; 6(6):723-724. PMC: 8574132. DOI: 10.1001/jamacardio.2021.0284. View

16.

Kang G, Ha R, Banerjee D . Pulmonary artery pulsatility index predicts right ventricular failure after left ventricular assist device implantation. J Heart Lung Transplant. 2015; 35(1):67-73. DOI: 10.1016/j.healun.2015.06.009. View

17.

Landoni G, Lomivorotov V, Alvaro G, Lobreglio R, Pisano A, Guarracino F . Levosimendan for Hemodynamic Support after Cardiac Surgery. N Engl J Med. 2017; 376(21):2021-2031. DOI: 10.1056/NEJMoa1616325. View

18.

Hernandez-Montfort J, Xie R, Ton V, Meyns B, Nakatani T, Yanase M . Longitudinal impact of temporary mechanical circulatory support on durable ventricular assist device outcomes: An IMACS registry propensity matched analysis. J Heart Lung Transplant. 2019; 39(2):145-156. DOI: 10.1016/j.healun.2019.11.009. View

19.

Scherer M, Sirat A, Moritz A, Martens S . Extracorporeal membrane oxygenation as perioperative right ventricular support in patients with biventricular failure undergoing left ventricular assist device implantation. Eur J Cardiothorac Surg. 2010; 39(6):939-44. DOI: 10.1016/j.ejcts.2010.09.044. View

20.

Yoshioka D, Takayama H, Colombo P, Yuzefpolskaya M, Garan A, Topkara V . Changes in End-Organ Function in Patients With Prolonged Continuous-Flow Left Ventricular Assist Device Support. Ann Thorac Surg. 2017; 103(3):717-724. DOI: 10.1016/j.athoracsur.2016.12.018. View