Biventricular and Isolated Right Ventricular Support

Heart transplantation remains the primary treatment for biventricular heart failure, mechanical circulatory support (MCS) is often needed for stabilization to allow for clinical decision-making regarding candidacy for recovery, durable MCS, or transplant. Patients with isolated right ventricular failure or biventricular failure have higher mortality compared with those patients with left ventricular failure alone. Right heart failure is defined by the Interagency Registry for Mechanically Assisted Circulatory Support as the presence of at least two clinical signs (ascites, peripheral edema, elevated estimated and measured jugular venous pressure) and associated with renal failure, liver injury, mixed venous oxygen saturation < 50%, cardiac index <2.2 L/min/m,(Kapelios CJ, Lund LH, Wever-Pinzon O, Selzman CH, Myers SL, Cantor RS, Circ Heart Fail 15:e008706, 2022) reduction in pump flow of >30%, or lactate >3.0 mmol/L. Right ventricular support with or without left ventricular support is more commonly temporary. When patients are being bridged to transplant or are not transplant candidates, they may require a more durable option for isolated right heart failure or more likely biventricular support. Weaning from support is generally individualized and institution specific. Readiness to wean from support should be assessed once end-organ perfusion appears adequate as defined by normalizing lactate and improving right and left sided pulsatility on minimal vasoactive support. Right ventricular failure remains a significant clinical problem both in prediction and management. Patient outcomes are poor compared with those patients with isolated left ventricular failure.