Mechanical circulatory support for right ventricular failure: RVADs

Abstract

Heart failure is the basic and featured pathologic leading cause of death. From a clinical perspective, the most important objectives in caring for heart failure patients are diagnosis of the underlying mechanism and delivery of appropriate, effective treatment. In the majority of cases, the left ventricle is affected but the right ventricle functions normally until the end stage. Right ventricular failure (RVF) results from weakening of the right ventricular structures and/or by an increase in pulmonary vascular resistance. Post-implant RVF, a third type has been recognized in the last two decades. Right ventricular failure results in poor filling of the left ventricle and poor output, often necessitating additional right ventricular support in the form of inotropes or a mechanical right ventricular assist device (RVAD). Temporary mechanical support devices increase pulmonary blood circulation with or without extracorporeal oxygenation to provide adequate cardiac output. The preferred approach is to insert a temporary mechanical support device in percutaneous va-ECCPS configuration for acute RVF in the intensive care unit or in surgical vp-ECCS configuration for post-implant RVF in the operating room. For longer use, right ventricular or biventricular assist devices are used to provide circulatory support. Permanent RVADs provide a parallel or series artificial circulation to substitute for failed ventricles or they take over completely the pump function of a resected heart. Short-term RVADs are extracorporeal or paracorporeal pumps located outside the body, whereas durable RVADs are implanted inside the body. A novel development will be a true artificial heart without a need for anticoagulants; however, heart transplantation is still the gold standard for curative treatment.