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Mechanical Circulatory Support for Biventricular Failure: Patient Selection and Management Options

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Mechanical Support for Heart Failure

Abstract

Nearly half of all individuals with heart failure with reduced ejection fraction have biventricular dysfunction. By unloading the left ventricle and decreasing left atrial pressures, there is a reasonable chance for right ventricular recovery after left ventricular assist device. Unfortunately, the opposite is also true where right ventricular failure can be unmasked, develop, or worsen. This chapter will focus on the patient selection and management of individuals with pre-existing biventricular failure either from chronic left ventricular failure or dilated cardiomyopathies, as well as those who develop right ventricular failure after left ventricular assist devices have been placed. We will discuss methods for risk stratifying individuals with biventricular dysfunction and pre-, peri-, and postoperative management strategies for improving right ventricular recovery and survival to transplant in these patients.

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Abbreviations

BiVAD:

Biventricular assist device

CVP:

Central venous pressure

EF:

Ejection fraction

LVAD:

Left ventricular assist device

iNO:

Inhaled nitric oxide

INTERMACS:

Interagency Registry for Mechanically Assisted Circulatory Support

ISHLT:

International Society for Heart and Lung Transplantation

PAPi:

Pulmonary artery pulsatility index

PCWP:

Pulmonary capillary wedge pressure

PVR:

Pulmonary vascular resistance

MAP:

Mean arterial pressure

MR:

Mitral regurgitation

MVS:

Mitral valve surgery

RAP:

Right atrial pressure

RHC:

Right heart catheterization

RVAD:

Right ventricular assist device

RVF:

Right ventricular failure

RVSWI:

Right ventricular stroke work index

TR:

Tricuspid regurgitation

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Authors and Affiliations

  1. Department of Cardiology, University of California San Diego, La Jolla, CA, USA

    Kimberly N. Hong MD, MHSA1 & Hao A. Tran MD

  2. Department of Cardiothoracic Surgery, University of California San Diego, La Jolla, CA, USA

    Victor Pretorius MD

  3. University of California San Diego Medical Center, San Diego, CA, USA

    Eric D. Adler MD

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  1. Kimberly N. Hong MD, MHSA1
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  1. Lerner Research Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Cleveland Clinic, Cleveland, OH, USA

    Jamshid H. Karimov

  2. Lerner Research Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Cleveland Clinic, Cleveland, OH, USA

    Kiyotaka Fukamachi

  3. Kaufman Center for Heart Failure Heart, Thoracic, and Vascular Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Cleveland Clinic, Cleveland, OH, USA

    Randall C. Starling

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Hong, K.N., Tran, H.A., Pretorius, V., Adler, E.D. (2020). Mechanical Circulatory Support for Biventricular Failure: Patient Selection and Management Options. In: Karimov, J., Fukamachi, K., Starling, R. (eds) Mechanical Support for Heart Failure . Springer, Cham. https://doi.org/10.1007/978-3-030-47809-4_13

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  • DOI: https://doi.org/10.1007/978-3-030-47809-4_13

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-47808-7

  • Online ISBN: 978-3-030-47809-4

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