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Semin Cardiothorac Vasc Anesth · Dec 2013
ReviewPreoperative evaluation and perioperative management of right ventricular failure after left ventricular assist device implantation.
- Lucas N Marzec and Amrut V Ambardekar.
- 1University of Colorado, Aurora, CO, USA.
- Semin Cardiothorac Vasc Anesth. 2013 Dec 1;17(4):249-61.
AbstractRight ventricular (RV) failure continues to be a major cause of morbidity and mortality after left ventricular assist device (LVAD) implantation. Preoperative evaluation of RV function with a variety of clinical, laboratory, echocardiographic, and hemodynamic variables is essential to ensure appropriate patient selection for LVAD therapy but remains imperfect. Therefore, clinicians involved in the care of these patients need to be prepared to manage RV failure after LVAD placement. Perioperative management of RV failure after LVAD implantation requires minimization of intraoperative RV ischemia, maintenance of appropriate filling pressure, supportive therapy with pulmonary vasodilators and inotropes, and surgical interventions such as RV assist devices in select cases. This article reviews the incidence of RV failure with LVAD implantation, preoperative predictors of RV failure, and perioperative management strategies.
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