The risk of right ventricular failure with current continuous-flow left ventricular assist devices

Introduction: Right ventricular failure (RVF) still results as the major cause of morbidity and mortality after left ventricular assist device (LVAD) implantation. Despite overall improved outcomes and lower rates of RVF with the use of the newer, continuous-flow (CF) LVADs over pulsatile-flow devices, and development of clinical prediction scores to facilitate preoperative identification of patients at risk for RVF after implantation, RVF occurs in 13% to 40% of continuous-flow device. Areas covered: In this article, a review has been carried out on the current evidence for preoperative assessment of RV function and RVF risk for appropriate patient selection mainly focusing on current imaging and invasive assessment tools. Expert commentary: According to all findings, it is recommended that measurements of RV function should be included in all risk predictions models and that standardization of echocardiographic and hemodynamic evaluation protocols be adopted before and after device implantation across LVAD centers. The balance of well-accepted and fixed multiple variables might be able to better predict the outcomes in such a delicate clinical panorama.