Right ventricular failure post-implantation of left ventricular assist device: Prevalence, pathophysiology, and predictors

Hyeon Ju R. Ali, Michael S. Kiernan, Gaurav Choudhary, Daniel J. Levine, Neel R. Sodha, Afshin Ehsan, Rayan Yousefzai

Research output: Contribution to journalReview article

2 Scopus citations

Abstract

Despite advances in left ventricular assist device (LVAD) technology, right ventricular failure (RVF) continues to be a complication after implantation. Most patients undergoing LVAD implantation have underlying right ventricular (RV) dysfunction (either as a result of prolonged LV failure or systemic disorders) that becomes decompensated post-implantation. Additional insults include intra-operative factors or a sudden increase in preload in the setting of increased cardiac output. The current literature estimates post-LVAD RVF from 3.9% to 53% using a diverse set of definitions. A few of the risk factors that have been identified include markers of cardiogenic shock (e.g., dependence on inotropes and Interagency Registry for Mechanically Assisted Circulatory Support profiles) as well as evidence of cardiorenal or cardiohepatic syndromes. Several studies have devised multivariable risk scores; however, their performance has been limited. A new functional assessment of RVF and a novel hepatic marker that describe cholestatic properties of congestive hepatopathy may provide additional predictive value. Furthermore, future studies can help better understand the relationship between pulmonary hypertension and post-LVAD RVF. To achieve our ultimate goal - to prevent and effectively manage RVF post-LVAD - we must start with a better understanding of the risk factors and pathophysiology. Future research on the different etiologies of RVF - ranging from acute post-surgical complication to late-onset RV cardiomyopathy - will help standardize definitions and tailor therapies appropriately.

Original languageEnglish (US)
Pages (from-to)610-619
Number of pages10
JournalASAIO Journal
Volume66
Issue number6
DOIs
StatePublished - Jun 1 2020

Keywords

  • heart failure
  • right ventricular failure
  • risk factors
  • ventricular assist device

ASJC Scopus subject areas

  • Biophysics
  • Bioengineering
  • Biomaterials
  • Biomedical Engineering

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