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Peer-reviewedCC BY 4.0Cardiovascular Therapeutics

Early Right Heart Failure After Left Ventricular Assist Device Implantation: A Narrative Review of Definitions, Risk Prediction, and Management

  • Qing Gao1
  • Shujie Yan1
  • Kunyu Li1
  • Luyang Xu1
  • Guodong Gao1
  • Qiang Hu1
  • Jinping Liu2
  • Bingyang Ji1
  1. 1Department of Cardiopulmonary Bypass Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China pumc.edu.cn
  2. 2Pediatric Cardiac Center Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China pumc.edu.cn
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Abstract

Early right heart failure (RHF) remains common after left ventricular assist device (LVAD) implantation and is associated with substantial morbidity and mortality. Definition and time window determine reported incidence and complicate risk‐model comparison. Established risk models perform differently across cohorts and device eras, and temporary support should be matched to the dominant physiology. LV unloading alters venous return, septal geometry, and right ventricular (RV) loading, whereas perioperative stress exposes limited RV reserve. No single clinical, imaging, or hemodynamic measure reliably predicts early RHF, and existing scores perform variably on external validation. Dynamic hemodynamic assessment adds information about RV reserve and warrants prospective threshold validation. Management begins by addressing reversible causes and optimizing LVAD support. When temporary mechanical support is required, RV‐specific bypass restores pulmonary forward flow, an oxygenated right atrial‐to‐pulmonary arterial RVAD adds gas exchange, and venoarterial extracorporeal membrane oxygenation provides broader rescue for combined circulatory and respiratory failure. Comparative evidence on timing and configuration remains observational.

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Cite

BibTeXRIS
BibTeX
@article{gao2026early,
  title = {{Early Right Heart Failure After Left Ventricular Assist Device Implantation: A Narrative Review of Definitions, Risk Prediction, and Management}},
  author = {Qing Gao and Shujie Yan and Kunyu Li and Luyang Xu and Guodong Gao and Qiang Hu and Jinping Liu and Bingyang Ji},
  journal = {Cardiovascular Therapeutics},
  year = {2026},
  month = oct,
  doi = {10.1155/cdr/2611216},
  url = {https://doi.org/10.1155/cdr/2611216},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Early Right Heart Failure After Left Ventricular Assist Device Implantation: A Narrative Review of Definitions, Risk Prediction, and Management
AU  - Qing Gao
AU  - Shujie Yan
AU  - Kunyu Li
AU  - Luyang Xu
AU  - Guodong Gao
AU  - Qiang Hu
AU  - Jinping Liu
AU  - Bingyang Ji
PY  - 2026
DA  - 2026/10/27
JO  - Cardiovascular Therapeutics
DO  - 10.1155/cdr/2611216
UR  - https://doi.org/10.1155/cdr/2611216
AB  - Early right heart failure (RHF) remains common after left ventricular assist device (LVAD) implantation and is associated with substantial morbidity and mortality. Definition and time window determine reported incidence and complicate risk‐model comparison. Established risk models perform differently across cohorts and device eras, and temporary support should be matched to the dominant physiology. LV unloading alters venous return, septal geometry, and right ventricular (RV) loading, whereas perioperative stress exposes limited RV reserve. No single clinical, imaging, or hemodynamic measure reliably predicts early RHF, and existing scores perform variably on external validation. Dynamic hemodynamic assessment adds information about RV reserve and warrants prospective threshold validation. Management begins by addressing reversible causes and optimizing LVAD support. When temporary mechanical support is required, RV‐specific bypass restores pulmonary forward flow, an oxygenated right atrial‐to‐pulmonary arterial RVAD adds gas exchange, and venoarterial extracorporeal membrane oxygenation provides broader rescue for combined circulatory and respiratory failure. Comparative evidence on timing and configuration remains observational.
SN  - 1755-5914
SN  - 1755-5922
ER  -