Right ventricular (RV) failure refractory to medical therapy is associated with a poor prognosis in cardiogenic shock. Because of the RV remarkable properties to rApidly recover under favorable hemodynamic conditions, the use of RV acute mechanical circulatory support (AMCS) devices may represent a new option to promptly stabilize the patient and change prognosis. If giant leaps forward have been made in left ventricle AMCS technology and clinical use, devices to support the right ventricle are still moving their first steps in the clinical arena. While surgically implanted RV assist devices may provide durable, long-term support when this need is anticipated, percutaneous RV-AMCS (RV-pAMCS) devices are emerging as a minimally invasive alternative, able to guarantee faster decision-making and early intervention, and with the potential to lower complications and improve survival.In this review, after summarizing the epidemiology and the pathophysiology of acute RV failure, we focuson the mechanisms of action, characteristics and clinical evidence relating to the currently available RVpAMCS devices. We further provide an algorithm embedding relevant aspects of clinical decision-making, when RV-AMCS is considered.
Percutaneous mechanical circulatory support devices: A new treatment option for refractory right ventricular failure
Gallone G.;Giannini F.
2018-01-01
Abstract
Right ventricular (RV) failure refractory to medical therapy is associated with a poor prognosis in cardiogenic shock. Because of the RV remarkable properties to rApidly recover under favorable hemodynamic conditions, the use of RV acute mechanical circulatory support (AMCS) devices may represent a new option to promptly stabilize the patient and change prognosis. If giant leaps forward have been made in left ventricle AMCS technology and clinical use, devices to support the right ventricle are still moving their first steps in the clinical arena. While surgically implanted RV assist devices may provide durable, long-term support when this need is anticipated, percutaneous RV-AMCS (RV-pAMCS) devices are emerging as a minimally invasive alternative, able to guarantee faster decision-making and early intervention, and with the potential to lower complications and improve survival.In this review, after summarizing the epidemiology and the pathophysiology of acute RV failure, we focuson the mechanisms of action, characteristics and clinical evidence relating to the currently available RVpAMCS devices. We further provide an algorithm embedding relevant aspects of clinical decision-making, when RV-AMCS is considered.
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