Abstract
Implantation of left ventricular assist devices (LVAD) is now an established treatment in
patients with end-stage heart failure (HF). Despite improvements in technology and
perioperative care, right ventricular failure (RVF) is still a common, poorly predictable, and
often fatal complication. Planned biventricular assist device (BiVAD) therapy results in better
patient outcome than delayed right ventricular assist device (RVAD) implantation in response to
RVF after isolated LVAD implantation.
Therefore, the evaluation of right ventricular (RV) function prior to surgery is crucial and
diverse scoring systems have been proposed. However, they sensitivity and specificity are not
yet satisfactory. RV imaging is an attractive adjunct to clinical RV evaluation because it is noninvasive
and may offer greater sensitivity to change than markers of pre-existing RV failure. But
despite an increasing number of studies, standard echocardiographic predictors of RVF remain
inconsistent.
In the normal heart, the left ventricle (LV)generates between40 – 65% of the work of the RV
through the interventricular septum and the shared myofibers. Following LVAD implantation,
this ventricular contribution is diminished, while the RV output has to increase in order to
provide forward flow and fill the LVAD. This might unmask a previously asymptomatic RV
dysfunction.
To predict the response of the RV to the changed hemodynamic environment, we have to
evaluate the functional reserve of the RV. The concept of using stressto evaluate this ventricular
functional reserve is frequently applied in aortic stenosis to predict LV recovery. Dobutamineinduced
changes in echocardiographic parameters such as RV longitudinal strain and systolic
pulmonary artery pressure might best simulate the post-LVAD period and thereby predict how
the RV will respond.