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Medical and Mechanical Circulatory Support of the Failing Right Ventricle

  • Cardiovascular Critical Care (A Higgins and R Lee, Section Editors)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To describe medical therapies and mechanical circulatory support devices used in the treatment of acute right ventricular failure.

Recent Findings

Experts have proposed several algorithms providing a stepwise approach to medical optimization of acute right ventricular failure including tailored volume administration, ideal vasopressor selection to support coronary perfusion, inotropes to restore contractility, and pulmonary vasodilators to improve afterload. Studies have investigated various percutaneous and surgically implanted right ventricular assist devices in several clinical settings.

Summary

The initial management of acute right ventricular failure is often guided by invasive hemodynamic data tracking parameters of circulatory function with the use of pharmacologic therapies. Percutaneous microaxial and centrifugal extracorporeal pumps bypass the failing RV and support circulatory function in severe cases of right ventricular failure.

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Abbreviations

cGMP:

Cyclic guanosine monophosphate

CO:

Cardiac output

CVP:

Central venous pressure

EF:

Ejection fraction

ICU:

Intensive care unit

iNO:

Inhaled nitric oxide

LV:

Left ventricle

LVAD:

Left ventricular assist device

LVEDV:

Left ventricular end-diastolic volume

MAP:

Mean arterial pressure

MCS:

Mechanical circulatory support

MI:

Myocardial infarction

PA:

Pulmonary artery

PADP:

Pulmonary artery diastolic pressure

PAPi:

Pulmonary artery pulsatility index

PASP:

Pulmonary artery systolic pressure

PCWP:

Pulmonary capillary wedge pressure

PE:

Pulmonary embolism

PEEP:

Positive end-expiratory pressure

PPV:

Positive pressure ventilation

PVR:

Pulmonary vascular resistance

RA:

Right atrium

RAP:

Right atrial pressure

RV:

Right ventricle

RVAD:

Right ventricular assist device

RVEDV:

Right ventricular end-diastolic volume

RVSWI:

Right ventricular stroke work index

SV:

Stroke volume

VA ECMO:

Venoarterial extracorporeal membrane oxygenation

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, NYU Langone Health, 530 First Ave. Skirball 9R, New York, NY, 10016, USA

    Eugene Yuriditsky & James M. Horowitz

  2. Department of Cardiology, Department of Cardiac Surgery, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA

    Meshe Chonde

  3. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Oren Friedman

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EY wrote the main manuscript text, created Table 1. MC wrote the main manuscript text, created Table 2. OF wrote the main manuscript text. JH wrote the main manuscript text.

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James M. Horowitz reports consulting fees from Inari Medical and Penumbra for clinical trial design. The other authors report no conflict of interest pertinent to this manuscript.

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Yuriditsky, E., Chonde, M., Friedman, O. et al. Medical and Mechanical Circulatory Support of the Failing Right Ventricle. Curr Cardiol Rep 26, 23–34 (2024). https://doi.org/10.1007/s11886-023-02012-3

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