Risk Stratification and Optimization to Prevent Right Heart Failure During Left Ventricular Assist Device Implantation

Left ventricular assist device (LVAD) implantation results in superior survival rates compared with optimal medical therapy in patients with end -stage heart failure. However, a potential complication of LVAD implantation is right heart failure (RHF), which can be devastating. Therefore, identifying preoperative risk factors for RHF and optimal management for these patients are critical for ensuring favorable postoperative out-comes. This review focuses on methods of assessing the risk factors for RHF before surgery, including evaluation of biomarkers, echocardiogra-phy, hemodynamics, risk-scoring systems, and existing conditions of right heart dysfunction. In addition, the review also explores the perioperative strategic approaches to reducing the likelihood of RHF. (c) 2020 Elsevier Inc. All rights reserved.