Accurate assessment of right heart function before and after long-term left ventricular assist device implantation.

INTRODUCTION: Because end-stage heart failure (HF) often involves both ventricles even if its initial cause was left-sided heart disease, assessment of RV size, geometry and function before, during and after LVAD implantation is of crucial importance. AREAS COVERED: This review discusses the usefulness, benefits, particular challenges and limits of RV assessment in patients with end-stage HF due to primarily impaired LV function who necessitate LVAD support, with or without an additional RV mechanical support. EXPERT OPINION: Although LV unloading often induces reduction of the pulmonary vascular resistance facilitating RV reverse remodeling and functional improvement, drug-refractory RVF after LVAD implantation is not always avoidable. Therefore, patients who need a temporary or long-term biventri-cular mechanical support should already be identified preoperatively or at the latest intraoperatively. Proper assessment of RV function and its adaptability to hemodynamic overloading before LVAD implantation can predict post-implant RVF, thus helping to avoid complications generated by unforeseen RVF in LVAD recipients. Close monitoring of RV size, geometry and function in LVAD recipients with and without additional RV mechanical support is essential for early recognition of imminent RVF in those without RV support and for detection of RV recovery and weaning decision-making in those with a RV support.