Management of Right Ventricular Failure in Pulmonary Hypertension (and After LVAD Implantation)

Right ventricular failure (RVF) is increasingly recognized as a complicating feature of a number of disease states, including pulmonary arterial hypertension (PAH) and advanced heart failure. It not only contributes to symptoms and complicates management, but also dramatically impacts prognosis. In PAH, early disease detection and institution of PAH therapy can prevent or delay RVF. Once established, therapy for RVF focuses on optimizing afterload reduction with PAH therapy, controlling volume, and judiciously using inotropic support when needed. In patients undergoing implantation of a LVAD, preoperative assessment and management of RVF is critical. Risk factors for the development of RVF after LVAD have been described, and may identify a population best managed with biventricular support. Postoperative management of RVF focuses on supportive therapy, judicious use of inotropes and volume management. Ongoing research may yield insights into specific therapies to prevent or reverse RVF.