Abstract
Right ventricular failure (RVF) in the era of left ventricular assist device (LVAD) therapy remains a significant problem. Approximately 6% to 10% of patients with an LVAD will require the implantation of a right ventricular assist device (RVAD) (1) with an additional 15% to 20% requiring prolonged inotropic support for RVF (2,3). Several mechanisms may contribute to RVF post LVAD implantation, most importantly the unloading of the left ventricle and resultant loss of septal contribution to right ventricular (RV) function. In addition, perioperative factors such as myocardial ischemia can further compromise a vulnerable right ventricle. As these factors may lead to rescue implantation of an RVAD, which is associated with increased mortality (4), research should focus on identifying patients that would benefit from preemptive implantation of an RVAD. Here we highlight recent advances in the field, focusing on risk stratification scores, the use of pulmonary vasodilators, the use of biventricular assist devices (BIVAD) versus a total artificial heart (TAH), and the use of a temporary RVAD (tRVAD). We also briefly present recent data on right heart recovery post LVAD using tRVAD support.
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