Right ventricular failure after LVAD implantation: prevention and treatment.
Right ventricular failure (RVF) complicates 20-50% of left ventricular assist device (LVAD) implantation cases and contributes to increased postoperative morbidity and mortality. Normal LVAD function alters the highly compliant right ventricular (RV) physiology, which may unmask RVF. Risk scores for predicting RVF post-LVAD incorporate multiple risk factors but have not been prospectively validated. Prevention of RVF consists of optimising RV function by modifying RV preload and afterload, providing adequate intra-operative RV protection and minimising blood transfusions. Treatment of RVF relies on inotropic support, decreasing pulmonary vascular resistance and adjusting LVAD flows to minimise distortion of RV geometry. RVAD insertion is a last recourse when RVF is refractory to medical treatment.
University of Toronto, Staff Anaesthesiologist, Toronto General Hospital, Department of Anaesthesia and Pain Management, 200 Elizabeth Street, EN 3-442, Toronto, ON, Canada M5G 2C4. massimiliano.meineri@uhn.ca
Massimiliano
M
Meineri
Adriaan E
AE
Van Rensburg
Annette
A
Vegas
D001803:Blood Transfusion / Q000379:methods; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D018570:Risk Assessment; D012307:Risk Factors; D014655:Vascular Resistance; D018497:Ventricular Dysfunction, Right / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D016278:Ventricular Function, Right