Right heart failure with left ventricular assist devices: Preoperative, perioperative and postoperative management strategies. A clinical consensus statement of the Heart Failure Association (HFA) of the ESC
Adamopoulos S. Bonios M. Ben Gal T. Gustafsson F. Abdelhamid M. Adamo M. Bayes-Genis A. Böhm M. Chioncel O. Cohen-Solal A. Damman K. Di Nora C. Hashmani S. Hill L. Jaarsma T. Jankowska E. Lopatin Y. Masetti M. Mehra M.R. Milicic D. Moura B. Mullens W. Nalbantgil S. Panagiotou C. Piepoli M. Rakisheva A. Ristic A. Rivinius R. Savarese G. Thum T. Tocchetti C.G. Tops L.F. Van Laake L.W. Volterrani M. Seferovic P. Coats A. Metra M. Rosano G.
November 2024John Wiley and Sons Ltd
European Journal of Heart Failure
2024#26Issue 112304 - 2322 pp.
Right heart failure (RHF) following implantation of a left ventricular assist device (LVAD) is a common and potentially serious condition with a wide spectrum of clinical presentations with an unfavourable effect on patient outcomes. Clinical scores that predict the occurrence of right ventricular (RV) failure have included multiple clinical, biochemical, imaging and haemodynamic parameters. However, unless the right ventricle is overtly dysfunctional with end-organ involvement, prediction of RHF post-LVAD implantation is, in most cases, difficult and inaccurate. For these reasons optimization of RV function in every patient is a reasonable practice aiming at preparing the right ventricle for a new and challenging haemodynamic environment after LVAD implantation. To this end, the institution of diuretics, inotropes and even temporary mechanical circulatory support may improve RV function, thereby preparing it for a better adaptation post-LVAD implantation. Furthermore, meticulous management of patients during the perioperative and immediate postoperative period should facilitate identification of RV failure refractory to medication. When RHF occurs late during chronic LVAD support, this is associated with worse long-term outcomes. Careful monitoring of RV function and characterization of the origination deficit should therefore continue throughout the patients entire follow-up. Despite the useful information provided by the echocardiogram with respect to RV function, right heart catheterization frequently offers additional support for the assessment and optimization of RV function in LVAD-supported patients. In any patient candidate for LVAD therapy, evaluation and treatment of RV function and failure should be assessed in a multidimensional and multidisciplinary manner.
Left ventricular assist device , Optimization of right ventricular function , Right heart failure
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Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece
Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
Faculty of Medicine, Department of Cardiology, Cairo University, Giza, Egypt
Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
Heart Failure and Cardiac Regeneration Research Program, Health Sciences Research Institute Germans Trias i Pujol, Barcelona, Spain
CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
Cardiology Service, Germans Trias i Pujol University Hospital, Barcelona, Spain
Clinic for Internal Medicine III (Cardiology, Intensive Care Medicine and Angiology), Saarland University Medical Center, Homburg, Germany
Emergency Institute for Cardiovascular Diseases ‘Prof C.C. Iliescu’, Bucharest, Romania
University of Medicine Carol Davila, Bucharest, Romania
Hospital Lariboisiere, Paris, France
University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
Cardiovascular Department, University of Trieste, Trieste, Italy
Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
School of Nursing & Midwifery, Queens University, Belfast, United Kingdom
Department of Health, Medicine and Caring Sciences, Linkoping University, Linköping, Sweden
Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland
Volgograd State Medical University, Regional Cardiology Centre, Volgograd, Russian Federation
Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Center for Advanced Heart Disease, Brigham and Womens Hospital and Harvard Medical School, Boston, MA, United States
Department of Cardiovascular Diseases, University of Zagreb School of Medicine & University Hospital Centre Zagreb, Zagreb, Croatia
Faculty of Medicine, University of Porto, Porto, Portugal
Ziekenhuis Oost-Limburg, Genk, Belgium
Cardiology Department, Faculty of Medicine, Ege University, İzmir, Turkey
IRCCS Policlinico San Donato, Milan, Italy
Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
Scientific Research Institute of Cardiology and Internal Medicine, Almaty, Kazakhstan
School of Medicine, University of Belgrade, Belgrade, Serbia
Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
German Center for Cardiovascular Research (DZHK), Heidelberg, Germany
Division of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
Institute of Molecular and Translational Therapeutic Strategies (IMTTS) and Rebirth Center for Translational Regenerative Therapies, Hannover Medical School, Hannover, Germany
Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
IRCCS San Raffaele, Rome, Italy
Faculty of Medicine, University of Belgrade, Serbia Academy of Sciences and Arts, Belgrade, Serbia
Heart Research Institute, Sydney, Australia
Cardiology. ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
St. Georges Hospitals NHS Trust University of London, London, United Kingdom
Heart Failure and Transplant Units
Heart Failure Unit
Department of Cardiology
Faculty of Medicine
Department of Medical and Surgical Specialties
Heart Failure and Cardiac Regeneration Research Program
CIBER Cardiovascular
Cardiology Service
Clinic for Internal Medicine III (Cardiology
Emergency Institute for Cardiovascular Diseases ‘Prof C.C. Iliescu’
University of Medicine Carol Davila
Hospital Lariboisiere
University of Groningen
Cardiovascular Department
Heart & Vascular Institute
School of Nursing & Midwifery
Department of Health
Institute of Heart Diseases
Volgograd State Medical University
Heart Failure and Transplant Unit
Center for Advanced Heart Disease
Department of Cardiovascular Diseases
Faculty of Medicine
Ziekenhuis Oost-Limburg
Cardiology Department
IRCCS Policlinico San Donato
Department of Biomedical Sciences for Health
Scientific Research Institute of Cardiology and Internal Medicine
School of Medicine
Department of Cardiology
German Center for Cardiovascular Research (DZHK)
Division of Cardiology
Institute of Molecular and Translational Therapeutic Strategies (IMTTS) and Rebirth Center for Translational Regenerative Therapies
Department of Translational Medical Sciences
Department of Cardiology
Department of Cardiology
IRCCS San Raffaele
Faculty of Medicine
Heart Research Institute
Cardiology. ASST Spedali Civili and Department of Medical and Surgical Specialties
St. Georges Hospitals NHS Trust University of London
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