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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

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 (...

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Main Authors: Adamopoulos, Stamatis (Author) , Bonios, Michael (Author) , Ben Gal, Tuvia (Author) , Gustafsson, Finn (Author) , Abdelhamid, Magdy (Author) , Adamo, Marianna (Author) , Bayes-Genis, Antonio (Author) , Böhm, Michael (Author) , Chioncel, Ovidiu (Author) , Cohen-Solal, Alain (Author) , Damman, Kevin (Author) , Di Nora, Concetta (Author) , Hashmani, Shahrukh (Author) , Hill, Loreena (Author) , Jaarsma, Tiny (Author) , Jankowska, Ewa (Author) , Lopatin, Yury (Author) , Masetti, Marco (Author) , Mehra, Mandeep R. (Author) , Milicic, Davor (Author) , Moura, Brenda (Author) , Mullens, Wilfried (Author) , Nalbantgil, Sanem (Author) , Panagiotou, Chrysoula (Author) , Piepoli, Massimo (Author) , Rakisheva, Amina (Author) , Ristic, Arsen (Author) , Rivinius, Rasmus (Author) , Savarese, Gianluigi (Author) , Thum, Thomas (Author) , Tocchetti, Carlo Gabriele (Author) , Tops, Laurens F. (Author) , Van Laake, Linda W. (Author) , Volterrani, Maurizio (Author) , Seferovic, Petar (Author) , Coats, Andrew (Author) , Metra, Marco (Author) , Rosano, Giuseppe (Author)
Format: Article (Journal)
Language:English
Published: 10 June 2024
In: European journal of heart failure
Year: 2024, Pages: 1-19
ISSN:1879-0844
DOI:10.1002/ejhf.3323
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1002/ejhf.3323
Verlag, lizenzpflichtig, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.3323
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Author Notes:Stamatis Adamopoulos, Michael Bonios, Tuvia Ben Gal, Finn Gustafsson, Magdy Abdelhamid, Marianna Adamo, Antonio Bayes-Genis, Michael Böhm, Ovidiu Chioncel, Alain Cohen-Solal, Kevin Damman, Concetta Di Nora, Shahrukh Hashmani, Loreena Hill, Tiny Jaarsma, Ewa Jankowska, Yury Lopatin, Marco Masetti, Mandeep R. Mehra, Davor Milicic, Brenda Moura, Wilfried Mullens, Sanem Nalbantgil, Chrysoula Panagiotou, Massimo Piepoli, Amina Rakisheva, Arsen Ristic, Rasmus Rivinius, Gianluigi Savarese, Thomas Thum, Carlo Gabriele Tocchetti, Laurens F. Tops, Linda W. Van Laake, Maurizio Volterrani, Petar Seferovic, Andrew Coats, Marco Metra, and Giuseppe Rosano
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Summary: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.
Item Description:Vorab veröffentlicht: 10. Juni 2024
Gesehen am 02.12.2024
Physical Description:Online Resource
ISSN:1879-0844
DOI:10.1002/ejhf.3323

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