Right heart failure after left ventricular assist device: From mechanisms to treatments.

Autor:	Bravo CA; Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, United States., Navarro AG; School of Medicine, University of Washington, Seattle, WA, United States., Dhaliwal KK; Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA, United States., Khorsandi M; Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA, United States., Keenan JE; Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA, United States., Mudigonda P; Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, United States., O'Brien KD; Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, United States., Mahr C; Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, United States.
Jazyk:	angličtina
Zdroj:	Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2022 Oct 19; Vol. 9, pp. 1023549. Date of Electronic Publication: 2022 Oct 19 (Print Publication: 2022).
DOI:	10.3389/fcvm.2022.1023549
Abstrakt:	Left ventricular assist device (LVAD) therapy is a lifesaving option for patients with medical therapy-refractory advanced heart failure. Depending on the definition, 5-44% of people supported with an LVAD develop right heart failure (RHF), which is associated with worse outcomes. The mechanisms related to RHF include patient, surgical, and hemodynamic factors. Despite significant progress in understanding the roles of these factors and improvements in surgical techniques and LVAD technology, this complication is still a substantial cause of morbidity and mortality among LVAD patients. Additionally, specific medical therapies for this complication still are lacking, leaving cardiac transplantation or supportive management as the only options for LVAD patients who develop RHF. While significant effort has been made to create algorithms aimed at stratifying risk for RHF in patients undergoing LVAD implantation, the predictive value of these algorithms has been limited, especially when attempts at external validation have been undertaken. Perhaps one of the reasons for poor performance in external validation is related to differing definitions of RHF in external cohorts. Additionally, most research in this field has focused on RHF occurring in the early phase (i.e., ≤1 month) post LVAD implantation. However, there is emerging recognition of late-onset RHF (i.e., > 1 month post-surgery) as a significant cause of morbidity and mortality. Late-onset RHF, which likely has a unique physiology and pathogenic mechanisms, remains poorly characterized. In this review of the literature, we will describe the unique right ventricular physiology and changes elicited by LVADs that might cause both early- and late-onset RHF. Finally, we will analyze the currently available treatments for RHF, including mechanical circulatory support options and medical therapies. Competing Interests: Author CM is an investigator and consultant for Abbott, Abiomed, and Carmat. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Bravo, Navarro, Dhaliwal, Khorsandi, Keenan, Mudigonda, O'Brien and Mahr.)
Databáze:	MEDLINE
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