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Right-Sided Mechanical Circulatory Support – A Hemodynamic Perspective

  • Focus on the Right Heart (S. Rosenkranz, Section Editor)
  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Right ventricular (RV) failure is increasingly recognized as a major cause of morbidity and mortality. When RV failure is refractory to medical therapy, escalation to right-sided mechanical circulatory support (MCS) should be considered. In this review, we begin by recapitulating the hemodynamics of RV failure, then we delve into current and future right-sided MCS devices and describe their hemodynamic profiles.

Recent Findings

The field of temporary right-sided MCS continues to expand, with evolving strategies and new devices actively under development. All right-sided MCS devices bypass the RV, with each bypass configuration conferring a unique hemodynamic profile. Devices that aspirate blood directly from the RV, as opposed to the RA or the IVC, have more favorable hemodynamics and more effective RV unloading. There has been a growing interest in single-access MCS devices which do not restrict patient mobility. Additionally, a first-of-its-kind percutaneous, pulsatile, right-sided MCS device (PERKAT RV) is currently undergoing investigation in humans.

Summary

Prompt recognition of refractory RV failure and deployment of right-sided MCS can improve outcomes. The field of right-sided MCS is rapidly evolving, with ongoing efforts dedicated towards developing novel temporary devices that are single access, allow for patient mobility, and directly unload the RV, as well as more durable devices.

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  1. Division of Cardiology, Columbia University Medical Center, 622 West 168th Street, Presbyterian Hospital, 3rd Floor, Room 347, New York, NY, 10032, USA

    Fatimah A. Alkhunaizi & Michael I. Brener

  2. Cardiovascular Research Foundation, New York, NY, USA

    Daniel Burkhoff

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Dr. Alkhunaizi declares no conflicts of interest. Dr. Burkhoff has received institutional educational grant support from Abiomed as well as consulting fees from CardioDyme Inc and from Abbott Laboratories. Dr. Brener is supported by an ACC/Merck Research Fellowship and has received consulting fees from Artract Medical and Osprey Medical.

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Alkhunaizi, F.A., Burkhoff, D. & Brener, M.I. Right-Sided Mechanical Circulatory Support – A Hemodynamic Perspective. Curr Heart Fail Rep 19, 334–345 (2022). https://doi.org/10.1007/s11897-022-00562-1

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  • DOI: https://doi.org/10.1007/s11897-022-00562-1

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