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

Stamatis Adamopoulos^#¹, Michael Bonios^#¹, Tuvia Ben Gal², Finn Gustafsson³, Magdy Abdelhamid⁴, Marianna Adamo⁵, Antonio Bayes-Genis^{6

7

8}, Michael Böhm⁹, Ovidiu Chioncel^{10

11}, Alain Cohen-Solal¹², Kevin Damman¹³, Concetta Di Nora¹⁴, Shahrukh Hashmani¹⁵, Loreena Hill¹⁶, Tiny Jaarsma¹⁷, Ewa Jankowska¹⁸, Yury Lopatin¹⁹, Marco Masetti²⁰, Mandeep R Mehra²¹, Davor Milicic²², Brenda Moura²³, Wilfried Mullens²⁴, Sanem Nalbantgil²⁵, Chrysoula Panagiotou¹, Massimo Piepoli^{26

27}, Amina Rakisheva²⁸, Arsen Ristic²⁹, Rasmus Rivinius^{30

31}, Gianluigi Savarese³², Thomas Thum³³, Carlo Gabriele Tocchetti³⁴, Laurens F Tops³⁵, Linda W Van Laake³⁶, Maurizio Volterrani³⁷, Petar Seferovic³⁸, Andrew Coats³⁹, Marco Metra⁴⁰, Giuseppe Rosano⁴¹

Affiliations

¹ Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece.
² Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
³ Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark.
⁴ Faculty of Medicine, Department of Cardiology, Cairo University, Giza, Egypt.
⁵ Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
⁶ Heart Failure and Cardiac Regeneration Research Program, Health Sciences Research Institute Germans Trias i Pujol, Barcelona, Spain.
⁷ CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.
⁸ Cardiology Service, Germans Trias i Pujol University Hospital, Barcelona, Spain.
⁹ Clinic for Internal Medicine III (Cardiology, Intensive Care Medicine and Angiology), Saarland University Medical Center, Homburg, Germany.
¹⁰ Emergency Institute for Cardiovascular Diseases 'Prof C.C. Iliescu', Bucharest, Romania.
¹¹ University of Medicine Carol Davila, Bucharest, Romania.
¹² Hospital Lariboisiere, Paris, France.
¹³ University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands.
¹⁴ Cardiovascular Department, University of Trieste, Trieste, Italy.
¹⁵ Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
¹⁶ School of Nursing & Midwifery, Queen's University, Belfast, UK.
¹⁷ Department of Health, Medicine and Caring Sciences, Linkoping University, Linköping, Sweden.
¹⁸ Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland.
¹⁹ Volgograd State Medical University, Regional Cardiology Centre, Volgograd, Russian Federation.
²⁰ Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
²¹ Center for Advanced Heart Disease, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
²² Department of Cardiovascular Diseases, University of Zagreb School of Medicine & University Hospital Centre Zagreb, Zagreb, Croatia.
²³ Faculty of Medicine, University of Porto, Porto, Portugal.
²⁴ Ziekenhuis Oost-Limburg, Genk, Belgium.
²⁵ Cardiology Department, Faculty of Medicine, Ege University, İzmir, Turkey.
²⁶ IRCCS Policlinico San Donato, Milan, Italy.
²⁷ Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
²⁸ Scientific Research Institute of Cardiology and Internal Medicine, Almaty, Kazakhstan.
²⁹ School of Medicine, University of Belgrade, Belgrade, Serbia.
³⁰ Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany.
³¹ German Center for Cardiovascular Research (DZHK), Heidelberg, Germany.
³² Division of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden.
³³ Institute of Molecular and Translational Therapeutic Strategies (IMTTS) and Rebirth Center for Translational Regenerative Therapies, Hannover Medical School, Hannover, Germany.
³⁴ Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy.
³⁵ Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
³⁶ Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
³⁷ IRCCS San Raffaele, Rome, Italy.
³⁸ Faculty of Medicine, University of Belgrade, Serbia Academy of Sciences and Arts, Belgrade, Serbia.
³⁹ Heart Research Institute, Sydney, Australia.
⁴⁰ Cardiology. ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
⁴¹ St. George's Hospitals NHS Trust University of London, London, UK.

^# Contributed equally.

PMID: 38853659
DOI: 10.1002/ejhf.3323

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

Stamatis Adamopoulos et al. Eur J Heart Fail. 2024 Nov.

. 2024 Nov;26(11):2304-2322.

doi: 10.1002/ejhf.3323. Epub 2024 Jun 10.

Authors

Affiliations

¹ Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece.
² Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
³ Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark.
⁴ Faculty of Medicine, Department of Cardiology, Cairo University, Giza, Egypt.
⁵ Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
⁶ Heart Failure and Cardiac Regeneration Research Program, Health Sciences Research Institute Germans Trias i Pujol, Barcelona, Spain.
⁷ CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.
⁸ Cardiology Service, Germans Trias i Pujol University Hospital, Barcelona, Spain.
⁹ Clinic for Internal Medicine III (Cardiology, Intensive Care Medicine and Angiology), Saarland University Medical Center, Homburg, Germany.
¹⁰ Emergency Institute for Cardiovascular Diseases 'Prof C.C. Iliescu', Bucharest, Romania.
¹¹ University of Medicine Carol Davila, Bucharest, Romania.
¹² Hospital Lariboisiere, Paris, France.
¹³ University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands.
¹⁴ Cardiovascular Department, University of Trieste, Trieste, Italy.
¹⁵ Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
¹⁶ School of Nursing & Midwifery, Queen's University, Belfast, UK.
¹⁷ Department of Health, Medicine and Caring Sciences, Linkoping University, Linköping, Sweden.
¹⁸ Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland.
¹⁹ Volgograd State Medical University, Regional Cardiology Centre, Volgograd, Russian Federation.
²⁰ Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
²¹ Center for Advanced Heart Disease, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
²² Department of Cardiovascular Diseases, University of Zagreb School of Medicine & University Hospital Centre Zagreb, Zagreb, Croatia.
²³ Faculty of Medicine, University of Porto, Porto, Portugal.
²⁴ Ziekenhuis Oost-Limburg, Genk, Belgium.
²⁵ Cardiology Department, Faculty of Medicine, Ege University, İzmir, Turkey.
²⁶ IRCCS Policlinico San Donato, Milan, Italy.
²⁷ Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
²⁸ Scientific Research Institute of Cardiology and Internal Medicine, Almaty, Kazakhstan.
²⁹ School of Medicine, University of Belgrade, Belgrade, Serbia.
³⁰ Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany.
³¹ German Center for Cardiovascular Research (DZHK), Heidelberg, Germany.
³² Division of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden.
³³ Institute of Molecular and Translational Therapeutic Strategies (IMTTS) and Rebirth Center for Translational Regenerative Therapies, Hannover Medical School, Hannover, Germany.
³⁴ Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy.
³⁵ Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
³⁶ Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
³⁷ IRCCS San Raffaele, Rome, Italy.
³⁸ Faculty of Medicine, University of Belgrade, Serbia Academy of Sciences and Arts, Belgrade, Serbia.
³⁹ Heart Research Institute, Sydney, Australia.
⁴⁰ Cardiology. ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
⁴¹ St. George's Hospitals NHS Trust University of London, London, UK.

^# Contributed equally.

PMID: 38853659
DOI: 10.1002/ejhf.3323

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.

Keywords: Left ventricular assist device; Optimization of right ventricular function; Right heart failure.

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References

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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

Affiliations

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

Authors

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Abstract

References

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LinkOut - more resources

Full Text Sources

Medical