Right heart failure with left ventricular assist devices: Preoperative, perioperative and postoperative management strategies. A clinical consensus statement of the Heart Failure Association (HFA) of the ESC

医学 心力衰竭 围手术期 心室 变向性 心脏病学 心室辅助装置 内科学 目的地治疗 血流动力学 重症监护医学 外科
作者
Stamatis Adamopoulos,Michael J. Bonios,Tuvia Ben Gal,Finn Gustafsson,Magdy Abdelhamid,Marianna Adamo,Antoni Bayés‐Genís,Michael Böhm,Ovidiu Chioncel,Alain Cohen‐Solal,Kevin Damman,Concetta Di Nora,Shahrukh Hashmani,Loreena Hill,Tiny Jaarsma,Ewa A. Jankowska,Yuri Lopatin,M. Masetti,Mandeep R. Mehra,Davor Milicić,Brenda Moura,Wilfried Müllens,Sanem Nalbantgil,Chrysoula Panagiotou,Massimo Piepoli,Amina Rakisheva,Arsen Ristić,Rasmus Rivinius,Gianluigi Savarese,Thomas Thum,Carlo G. Tocchetti,L. F. Tops,Linda W. van Laake,Maurizio Volterrani,Petar Seferović,Andrew J.S. Coats,Marco Metra,Giuseppe Rosano
出处
期刊:European Journal of Heart Failure [Wiley]
被引量:3
标识
DOI:10.1002/ejhf.3323
摘要

Abstract Right heart failure (RHF) following implantation of a left ventricular assist device (LVAD) is a common and potentially serious condition with a wide spectrum of clinical presentations with an unfavourable effect on patient outcomes. Clinical scores that predict the occurrence of right ventricular (RV) failure have included multiple clinical, biochemical, imaging and haemodynamic parameters. However, unless the right ventricle is overtly dysfunctional with end‐organ involvement, prediction of RHF post‐LVAD implantation is, in most cases, difficult and inaccurate. For these reasons optimization of RV function in every patient is a reasonable practice aiming at preparing the right ventricle for a new and challenging haemodynamic environment after LVAD implantation. To this end, the institution of diuretics, inotropes and even temporary mechanical circulatory support may improve RV function, thereby preparing it for a better adaptation post‐LVAD implantation. Furthermore, meticulous management of patients during the perioperative and immediate postoperative period should facilitate identification of RV failure refractory to medication. When RHF occurs late during chronic LVAD support, this is associated with worse long‐term outcomes. Careful monitoring of RV function and characterization of the origination deficit should therefore continue throughout the patient's entire follow‐up. Despite the useful information provided by the echocardiogram with respect to RV function, right heart catheterization frequently offers additional support for the assessment and optimization of RV function in LVAD‐supported patients. In any patient candidate for LVAD therapy, evaluation and treatment of RV function and failure should be assessed in a multidimensional and multidisciplinary manner.
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