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Ventricular Assist Devices in Advanced-Stage Heart Failure pp 113–129Cite as

Strategies to Assess and Minimize Right Heart Failure After Left Ventricular Assist Device Implantation

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Abstract

Objective: Despite the positive effects of decreased right ventricular afterload after implantation of a left ventricular assist device, the right ventricle may also sustain negative effects through changes in position of the interventricular septum and perioperative tricuspid regurgitation. Right ventricular failure, which occurs in 20–50 % of patients after left ventricular assist device implantation, is associated with substantial operative mortality and morbidity. Methods: This article reviews the pathology of and risk factors and management strategies for right ventricle failure after left ventricular assist device implantation. Results: Risk factors are female gender, non-ischemic cardiomyopathy, and preoperative mechanical support or intra-aortic balloon pumping; however, the significance of these findings was limited. Risk scoring systems have been developed to quantify this risk. Inotropes that induce pulmonary vasodilation, e.g., milrinone, accompanied by inotropes that increase systolic blood pressure, i.e., epinephrine, for coronary perfusion, are effective treatments for right ventricular failure. A specific pulmonary vasodilator, such as inhaled nitric oxide, which reduces pulmonary vascular resistance and increases device flow, is another important component of therapy. Because valvular pathologies can complicate postoperative management, correction of tricuspid regurgitation is necessary to decrease venous congestion and improve right ventricle function. Conclusions: Meticulous attention should be paid to optimizing preload, afterload, and contractility in patients with preexisting right ventricular dysfunction in order to prevent right ventricle failure after left ventricular assist device implantation. For intraoperative right ventricle failure, alternative measures of mechanical support, including a right ventricular assist device as a last resort, are used.

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  1. Department of Cardiovascular Surgery, Toronto General Hospital, Toronto, ON, Canada

    Michihito Nonaka & Vivek Rao

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  1. Michihito Nonaka
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  2. Vivek Rao
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Correspondence to Vivek Rao .

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  1. Dept. of The Therapeutic Strategy for Heart Failure, The University of Tokyo Hospital, Graduate School of Medicine, The University of Tokyo, Tokyo, Tokyo, Japan

    Shunei Kyo

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Nonaka, M., Rao, V. (2014). Strategies to Assess and Minimize Right Heart Failure After Left Ventricular Assist Device Implantation. In: Kyo, S. (eds) Ventricular Assist Devices in Advanced-Stage Heart Failure. Springer, Tokyo. https://doi.org/10.1007/978-4-431-54466-1_7

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  • DOI: https://doi.org/10.1007/978-4-431-54466-1_7

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