Predictors and impact of right heart failure severity following left ventricular assist device implantation

Right heart failure (RHF) is a common complication following left ventricular assist device (LVAD) placement, with prevalence reports ranging between 10–50% of patients (1-4). Left ventricular (LV) contractile forces contribute 20–40% of right ventricular (RV) output (4), and the hemodynamic effects of LVAD placement can have deleterious effects on native RV function (5). Modifying RV physiology by altering preload and afterload of the LV, optimizing RV protection, and minimizing blood transfusions intra-operatively have been shown to limit both RHF occurrence and progression. RHF following LVAD implantation, even when treated medically and with right ventricular assist device (RVAD) support, has been associated with increased hospital length of stay (LOS) and decreased survival of patients, even after successful cardiac transplantation (1,6-9). Although multiple risk factors for predicting RHF following LVAD implantation are available (10-12), the optimal method to anticipate this complication remains uncertain (13). Furthermore, the methods used for the diagnosis and categorization of RHF following LVAD are debated. Most definitions are based on a combination of hemodynamic derangement indicators and the duration of postoperative inotropes (1). This article aims to further delineate the contributing preoperative and intraoperative risk factors for RHF development following LVAD implantation and to demonstrate the effect of RHF on patients’ postoperative outcomes