title: Right ventricular failure--a continuing problem in patients with left ventricular assist device support.
abstract: The discrepancy between the limited availability of donor hearts and the ever-increasing number of patients with heart failure has led to the increasing use of left ventricular assist devices (LVAD) as a bridge to transplant. One of the main complications inherent following institution of LVAD therapy is right ventricular (RV) failure, manifested by the need for inotropic and/or nitric oxide support >14 days after LVAD implant and/or the need for right-sided mechanical circulatory support. RV failure is a major contributor of significant morbidity and mortality after LVAD placement. The complex pathophysiology of RV failure, which could potentially be related to RV myocardial dysfunction, interventricular dependence, and RV afterload, has led to inconsistencies in predicting risk factors for RV dysfunction. Several strategies have evolved over the years of experience with mechanical circulatory support that have aimed to avoid as well as reduce the incidence of RV failure. It is imperative that patients who definitely need biventricular support are identified. Despite the numerous risk factors identified in many studies as well as the development of risk factor profile scores, this continues to be a challenging problem. However, the lower incidence of RV failure following LVAD in the current era is encouraging, suggesting a favorable relationship between RV unloading and function, and continuous-flow physiology.
authors.affiliation: Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN 55455, USA. johnx008@umn.edu
authors.forename: Ranjit
authors.initials: R
authors.lastname: John
authors.forename: Sangjin
authors.initials: S
authors.lastname: Lee
authors.forename: Peter
authors.initials: P
authors.lastname: Eckman
authors.forename: Kenneth
authors.initials: K
authors.lastname: Liao
mesh_terms: D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006439:Hemodynamics; D006801:Humans; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
references.citation: N Engl J Med. 2001 Nov 15;345(20):1435-43
references.pmid: 11794191
references.citation: Ann Thorac Surg. 2002 Mar;73(3):745-50
references.pmid: 11899176
references.citation: J Heart Lung Transplant. 2009 Apr;28(4):360-6
references.pmid: 19332263
references.citation: World J Surg. 1985 Feb;9(1):89-102
references.pmid: 3885585
references.citation: Ann Thorac Surg. 2008 Oct;86(4):1227-34; discussion 1234-5
references.pmid: 18805167
references.citation: J Am Soc Echocardiogr. 1991 Mar-Apr;4(2):131-9
references.pmid: 2036225
references.citation: Ann Thorac Surg. 2004 Mar;77(3):859-63
references.pmid: 14992887
references.citation: Am J Cardiol. 2010 Apr 1;105(7):1030-5
references.pmid: 20346326
references.citation: J Heart Lung Transplant. 2006 Jan;25(1):1-6
references.pmid: 16399523
references.citation: Ann Thorac Surg. 2008 Sep;86(3):832-40; discussion 832-40
references.pmid: 18721570
references.citation: J Thorac Cardiovasc Surg. 1997 Jan;113(1):202-9
references.pmid: 9011691
references.citation: J Thorac Cardiovasc Surg. 2010 May;139(5):1316-24
references.pmid: 20132950
references.citation: J Heart Lung Transplant. 2008 Dec;27(12):1275-81
references.pmid: 19059106
references.citation: Circulation. 1985 Dec;72(6):1279-85
references.pmid: 4064272
references.citation: J Heart Lung Transplant. 2005 May;24(5):566-75
references.pmid: 15896754
references.citation: J Thorac Cardiovasc Surg. 2010 Jul;140(1):174-81
references.pmid: 20447659
references.citation: J Am Soc Echocardiogr. 2004 May;17(5):443-7
references.pmid: 15122184
references.citation: N Engl J Med. 2009 Dec 03;361(23):2241-51
references.pmid: 19920051
references.citation: Ann Thorac Surg. 2003 Jun;75(6 Suppl):S42-7
references.pmid: 12820734
references.citation: Circulation. 2002 Sep 24;106(12 Suppl 1):I198-202
references.pmid: 12354733
references.citation: Ann Thorac Surg. 2004 Jan;77(1):143-9; discussion 149-50
references.pmid: 14726050
references.citation: N Engl J Med. 2007 Aug 30;357(9):885-96
references.pmid: 17761592
references.citation: Ann Thorac Surg. 1998 Feb;65(2):340-5
references.pmid: 9485226
references.citation: J Heart Lung Transplant. 2010 Feb;29(2):209-15
references.pmid: 20113911
references.citation: J Heart Lung Transplant. 2005 Sep;24(9):1195-201
references.pmid: 16143233
references.citation: J Heart Lung Transplant. 2009 Apr;28(4):352-9
references.pmid: 19332262
references.citation: J Heart Lung Transplant. 1997 Apr;16(4):398-407
references.pmid: 9154950
references.citation: ASAIO J. 1992 Jul-Sep;38(3):M228-31
references.pmid: 1457854
references.citation: Ann Thorac Surg. 1999 Dec;68(6):2181-4
references.pmid: 10616999
references.citation: J Thorac Cardiovasc Surg. 2010 Aug;140(2):447-52
references.pmid: 20435321
references.citation: Ann Thorac Surg. 1996 Jan;61(1):350-6
references.pmid: 8561604
references.citation: Semin Thorac Cardiovasc Surg. 1994 Jul;6(3):163-8
references.pmid: 7948293
references.citation: J Heart Lung Transplant. 2008 Oct;27(10):1102-7
references.pmid: 18926401
references.citation: J Am Coll Cardiol. 2002 Apr 17;39(8):1247-54
references.pmid: 11955839
references.citation: Ann Thorac Surg. 2007 Jan;83(1):68-71; discussion 71
references.pmid: 17184632
references.citation: Artif Organs. 2005 May;29(5):369-77
references.pmid: 15854212
references.citation: ASAIO J. 1996 Sep-Oct;42(5):M733-5
references.pmid: 8944978
references.citation: Circulation. 2007 Sep 11;116(11 Suppl):I8-15
references.pmid: 17846330
references.citation: Ann Thorac Surg. 2007 May;83(5):1697-705
references.pmid: 17462383