A new "twist" on right heart failure with left ventricular assist systems

Brian A. Houston, Keyur B. Shah, Mandeep R. Mehra, Ryan J. Tedford

Research output: Contribution to journalArticle

Abstract

Despite significant efforts to predict and prevent right heart failure, it remains a leading cause of morbidity and mortality after implantation of left ventricular assist systems (LVAS). In this Perspective, we review the underappreciated anatomic and physiologic principles that govern the relationship between left and right heart function and contribute to this phenomenon. This includes the importance of considering the right ventricle (RV) and pulmonary arterial circuit as a coupled system; the contribution of the left ventricle (LV) to RV contractile function and the potential negative impact of acutely unloading the LV; the influence of the pericardium and ventricular twist on septal function; the role of RV deformation in reduced mechanical efficiency after device placement; and the potential of ongoing stressors of an elevated right-sided preload. We believe an appreciation of these complex issues is required to fully understand the expression of the unique phenotypes of right heart failure after LVAS implantation and for developing better prognostic and therapeutic strategies.

LanguageEnglish (US)
JournalJournal of Heart and Lung Transplantation
DOIs
StateAccepted/In press - 2017

Fingerprint

Heart Ventricles
Heart Failure
Pericardium
Morbidity
Phenotype
Equipment and Supplies
Lung
Mortality
Therapeutics

Keywords

  • Heart failure
  • Mechanical circulatory support
  • Physiology
  • Right heart
  • Right ventricle
  • Right ventricular failure
  • Ventricular assist device

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

A new "twist" on right heart failure with left ventricular assist systems. / Houston, Brian A.; Shah, Keyur B.; Mehra, Mandeep R.; Tedford, Ryan J.

In: Journal of Heart and Lung Transplantation, 2017.

Research output: Contribution to journalArticle

Houston, Brian A. ; Shah, Keyur B. ; Mehra, Mandeep R. ; Tedford, Ryan J./ A new "twist" on right heart failure with left ventricular assist systems. In: Journal of Heart and Lung Transplantation. 2017
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