Left ventricular assist device (LVAD) is
being used increasingly in recent years for end stage heart failure as a bridge
to transplant (BTT) and also as a destination therapy (DT). Patients with end
stage heart failure have some degree of elevated pulmonary capillary wedge
pressure, causing right ventricular hypertrophy which in due course leads to
decreased dilatation of the RV and fall in cardiac output & severe
tricuspid regurgitation (TR) presenting with features of RV failure (RVF).
Implantation of LVAD improves left heart function at the cost of right ventricular
output with an incidence of 25%-30%. RVF may lead to impaired LVAD flow,
difficulty in weaning from cardio-pulmonary bypass (CPB), decreased tissue
perfusion and multi-organ failure. In this article we comprehended the
pathophysiology leading to RVF post LVAD implantation and its preoperative
predictors and the various treatment modalities for managing RVF post LVAD
implantation.
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