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Year : 2020  |  Volume : 6  |  Issue : 3  |  Page : 216-225

Left Ventricle Can't Stay Alone – A Review of Right Ventricular Failure Post-Left Ventricular Assist Device Implantation

1 Intensive Care for CTVS, CT Centre, New Delhi, India
2 Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Dr. Manoj Kumar Sahu
Intensive care for CTVS, CT Centre, AIIMS, New Delhi - 110 029
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpcs.jpcs_63_20

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Background: Increasing incidence of heart failure with end-stage heart disease and limited availability of donor heart for transplantation made mechanical assist devices a lucrative option. Left ventricular assist device (LVAD) is used increasingly in recent years as a bridge to transplant and also as destination therapy with significantly improved outcomes. Implantation of LVAD improves the left heart systolic dysfunction, but its reliance on adequate right ventricular (RV) function with proposed risk of aggravating RV dysfunction may result in dismal outcomes if not intervened timely. Methodology: MeSH database was searched for LVAD, RV failure (RVF), RV anatomy and physiology, assessment for RV functions from 1990 till current year and was included in the narrative review. Results: The above searched English Medical Literature revealed that RVF contributed to dismal outcomes post-LVAD implantation. The absence of consistent defining criteria makes it hard to determine RVF. RVF leads to impaired LVAD flows, difficulty in weaning from cardio-pulmonary bypass, decreased tissue perfusion, and multi-organ failure, increasing the morbidity and mortality. Ideal durable mechanical assist devices to support the RV are still not available. Conclusion: This review highlights the details about perioperative assessment for RV dysfunction, criteria for RVF, investigational modalities to assess RV function, and management of RVF following LVAD implantation. Early identification, treatment, and prevention of RVF are of paramount importance and understanding this is a pivotal first step in successfully managing RVF post-LVAD implantation. The development of durable right-sided mechanical support would improve the scope of care of LVAD patients developing persistent RVF.

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