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Right Heart Failure Management: Focus on Mechanical Support Options

Published:February 22, 2022DOI:https://doi.org/10.1053/j.jvca.2022.02.022
      Millions of American adults suffer from right heart failure (RHF), a condition associated with high rates of hospitalization, organ failure, and death. There is a multitude of etiologies and mechanisms that lead to RHF, often in a feedforward spiral of decline. The management of advanced cases of RHF can be particularly difficult. For patients who are refractory to the medical optimization of volume status, hemodynamic and pharmacologic support, and rhythm control, mechanical therapies may be warranted. Currently available mechanical assist devices for RHF include venoarterial extracorporeal oxygenation and right ventricular assist devices, both surgical and percutaneous. Each advanced therapy has its own potential advantages and limitations, and often is appropriate in different clinical contexts. In this review, the authors describe the pathophysiology and medical therapies for RHF and then focus on the different types of advanced therapies that currently exist to help inform medical decision-making for this complicated patient cohort.

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      Linked Article

      • Advances in Mechanical Support for Right Ventricular Failure
        Journal of Cardiothoracic and Vascular AnesthesiaVol. 36Issue 8
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          The importance of recognition and management of right ventricular (RV) dysfunction is being recognized increasingly. In a variety of settings (acute myocardial infarction, cardiogenic shock, left ventricular failure, pulmonary hypertension) RV failure has been shown to increase both short- and long-term mortality.1 Furthermore, medical management of RV dysfunction is limited and frequently is impeded by the downstream effects of RV failure such as renal, liver, and left-sided cardiac dysfunction.
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