Title : Optimizing right ventricular function before LVAD implantation
Right ventricular (RV) failure complication following Left Ventricular Assist Device (LVAD) implantation increases morbidity and mortality in end-stage heart failure (HF) patients. Many prognostic markers of RV failure post LVAD implantation are used in various centers. For those patients that are at high risk for RV failure following LVAD implantation, many centers prefer to implant a biventricular mechanical circulatory support system. However, this option results in suboptimal outcomes, more complications and impaires patient’s life quality. For this reason, efforts are focusing to optimize RV function before LVAD implantation with various therapeutic strategies. These therapeutic options are mainly focused on the reduction of the RV preload, the increase of the RV contractility and the reduction of the RV afterload. Our Institution applies specific RV function eligibility prerequisite criteria for LVAD implantation, that are based on biochemistry, echocardiographic and hemodynamic parameters. In parallel we are trying to identify prognostic markers (ie RV extension fibrosis) that will help us to identify who of those patients that are in need for LVAD implantation and have in addition impaired RV function, can become eligible for LVAD by improving their RV function, applying various therapeutic options (ie prolonged heart unloading using intra-aortic balloon Counterpulsation) .