Right Heart Failure After Left Ventricular Assist Device Placement: Medical and Surgical Management Considerations

Abstract

Durable left ventricular assist device therapy is an increasingly accepted surgical therapy for advanced heart failure refractory to guideline-directed medical therapy. Right heart failure is a known and frequent complication after durable left ventricular assist device implantation and remains an important clinical challenge. Medical management of right heart failure after left ventricular assist device therapy focuses on improving right ventricular contractility and optimizing right ventricular preload and afterload. Mechanical circulatory support options include surgical and percutaneous devices options as well as the total artificial heart or heart transplantation. Early institution of therapy is necessary to reduce the morbidity and mortality.

Keywords: Heart failure; Heart transplantation; Left ventricular assist device; Mechanical circulatory assistance; Right heart failure; Right ventricular assist device; Total artificial heart.