Right heart failure after left ventricular assist device implantation:  early and late.
OBJECTIVE
To review recent publications on right heart failure developing early and late after implantation of left ventricular assist devices (LVAD).


RESULTS
Whereas use of the newer continuous flow devices is associated with improved outcomes, right heart failure remains a considerable challenge. Recent studies have provided good evidence about predicting right heart failure early after LVADs, though how to predict right heart failure late after LVAD is still unclear as most studies in this area are small single centre experience studies. With respect to medical therapies for treating right heart failure, there is evidence for the use of both nitric oxide and the phosphodiesterase type 5 inhibitor sildenafil in carefully selected patients with secondary pulmonary hypertension who undergo implantation of LVADs.


CONCLUSIONS
Despite improved outcomes, right heart failure remains a significant challenge to selecting and managing patients with LVADs, though we do have clearer evidence now for predicting early right heart failure, and treating it in those patients with secondary pulmonary hypertension.
Departments of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK. guy.macgowan@nuth.nhs.uk
Guy A
GA
MacGowan
Stephan
S
Schueler
D004868:Equipment Failure; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000473:pathology; D009569:Nitric Oxide / Q000627:therapeutic use; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D018570:Risk Assessment; D013997:Time Factors; D017211:Treatment Failure; D018497:Ventricular Dysfunction, Right
D058986:Phosphodiesterase 5 Inhibitors; D009569:Nitric Oxide