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Do actual medical literature depict a satisfactory view of Left ventricular assistant device and Right ventricular failure?

Elio Aloia, Matteo Cameli, Aleksander Dokollari, Gianluigi Buccoliero, Mario Stricagnoli, Cosimo Rizzo, Giulia Elena Mandoli, Aladino Ibrahim, Massimo Maccherini, Sergio Mondillo

Background: Incidence and prevalence of heart failure are rising up. In patients with advanced heart failure (AHF), Left Ventricular (LV) assist devices (LVADs) are an increasingly common therapy for AHF. Right ventricular failure (RVF) and device related issues make this therapy a challenge to apply to a broader population. On the other hand, RVF, after LVAD implantation, is associated with an increased incidence of perioperative mortality, prolonged length of stay and worst survival. Waiting for a randomized multicentre study, we just have to rely on clinical judgment of multidisciplinary experts, so the main goal of this review is to find out the relationship among LVAD and RVF.

Methods: We performed a meticulous online research on PubMed looking for the lateststudies on LVAD and BiVAD implantation, predictors of RVF and patients selectioncriteria in way to relate these variables with clinical outcomes.

Results: many studies were not randomized nor stratificated and there was aninhomogenity in the definition of RVF. In addition, no single variable adequately discriminates or is reliable for patient selection and BiVAD selection criteria were subjective and not objective in many cases.

Conclusions: We are far from a completely and clear knowledge about the prognosis of our patients It is time to find out new methods of evaluations in way to forsee RVF in patients that are going to be implanted with LVAD or BiVAD. Furthermore, new patients selection criteria must be established in way to overcome the increasing rate of RVF in implanted patients.