Document Type

Article

Original Publication Date

2017

Journal/Book/Conference Title

JOURNAL OF HEART AND LUNG TRANSPLANTATION

Volume

36

Issue

7

First Page

701

Last Page

707

DOI of Original Publication

10.1016/j.healun.2017.03.014

Comments

Originally published at http://doi.org/10.1016/j.healun.2017.03.014

Date of Submission

August 2017

Abstract

Despite significant efforts to predict and prevent right heart failure, it remains a leading cause of morbidity and mortality after implantation of left ventricular assist systems (LVAS). In this Perspective, we review the underappreciated anatomic and physiologic principles that govern the relationship between left and right heart function and contribute to this phenomenon. This includes the importance of considering the right ventricle (RV) and pulmonary arterial circuit as a coupled system; the contribution of the left ventricle (LV) to RV contractile function and the potential negative impact of acutely unloading the LV; the influence of the pericardium and ventricular twist on septal function; the role of RV deformation in reduced mechanical efficiency after device placement; and the potential of ongoing stressors of an elevated right-sided preload. We believe an appreciation of these complex issues is required to fully understand the expression of the unique phenotypes of right heart failure after LVAS implantation and for developing better prognostic and therapeutic strategies.

Rights

(C) 2017 International Society for Heart and Lung Transplantation. All rights reserved.

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