Right Ventricular Failure in Patients with Durable Mechanical Circulatory Support

Right ventricular (RV) failure is a common complication after Left Ventricular Assist Device (LVAD) implant. Right ventricular failure is present in 10–40% of patients undergoing LVAD implant and it is associated with increased 1 year mortality. Patients that underwent HeartMate II LVAD and HeartWare HVAD implant developed right ventricular failure nearly one third of the time (27.9%), with lower survival compared with those without RV failure. Management of RV failure is focused on medical therapy including diuretics, afterload reduction with pulmonary vasodilators, and inotropes like milrinone. In patients with severe RV failure refractory to medical management RV mechanical circulatory support (MCS) has been used with not very good results (58% 1-year survival). Recent analysis has shown that concomitant RV support at the time of implant can be associated with better 1 year mortality than patients that underwent RV MCS implant later after LVAD implant. The best approach to management is periop optimization of right ventricular function. If medical therapy is not enough, consideration for RVAD early or concomitant with LVAD implant has been associated with better outcomes. The decision for RVAD is center dependent.