Fatimah A Alkhunaizi1, Daniel Burkhoff2, Michael I Brener3. 1. Division of Cardiology, Columbia University Medical Center, 622 West 168th Street, Presbyterian Hospital, 3rd Floor, Room 347, New York, NY, 10032, USA. 2. Cardiovascular Research Foundation, New York, NY, USA. 3. Division of Cardiology, Columbia University Medical Center, 622 West 168th Street, Presbyterian Hospital, 3rd Floor, Room 347, New York, NY, 10032, USA. mib2102@cumc.columbia.edu.
Abstract
PURPOSE OF REVIEW: Right ventricular (RV) failure is increasingly recognized as a major cause of morbidity and mortality. When RV failure is refractory to medical therapy, escalation to right-sided mechanical circulatory support (MCS) should be considered. In this review, we begin by recapitulating the hemodynamics of RV failure, then we delve into current and future right-sided MCS devices and describe their hemodynamic profiles. RECENT FINDINGS: The field of temporary right-sided MCS continues to expand, with evolving strategies and new devices actively under development. All right-sided MCS devices bypass the RV, with each bypass configuration conferring a unique hemodynamic profile. Devices that aspirate blood directly from the RV, as opposed to the RA or the IVC, have more favorable hemodynamics and more effective RV unloading. There has been a growing interest in single-access MCS devices which do not restrict patient mobility. Additionally, a first-of-its-kind percutaneous, pulsatile, right-sided MCS device (PERKAT RV) is currently undergoing investigation in humans. Prompt recognition of refractory RV failure and deployment of right-sided MCS can improve outcomes. The field of right-sided MCS is rapidly evolving, with ongoing efforts dedicated towards developing novel temporary devices that are single access, allow for patient mobility, and directly unload the RV, as well as more durable devices.
PURPOSE OF REVIEW: Right ventricular (RV) failure is increasingly recognized as a major cause of morbidity and mortality. When RV failure is refractory to medical therapy, escalation to right-sided mechanical circulatory support (MCS) should be considered. In this review, we begin by recapitulating the hemodynamics of RV failure, then we delve into current and future right-sided MCS devices and describe their hemodynamic profiles. RECENT FINDINGS: The field of temporary right-sided MCS continues to expand, with evolving strategies and new devices actively under development. All right-sided MCS devices bypass the RV, with each bypass configuration conferring a unique hemodynamic profile. Devices that aspirate blood directly from the RV, as opposed to the RA or the IVC, have more favorable hemodynamics and more effective RV unloading. There has been a growing interest in single-access MCS devices which do not restrict patient mobility. Additionally, a first-of-its-kind percutaneous, pulsatile, right-sided MCS device (PERKAT RV) is currently undergoing investigation in humans. Prompt recognition of refractory RV failure and deployment of right-sided MCS can improve outcomes. The field of right-sided MCS is rapidly evolving, with ongoing efforts dedicated towards developing novel temporary devices that are single access, allow for patient mobility, and directly unload the RV, as well as more durable devices.
Authors: S Ghio; A Gavazzi; C Campana; C Inserra; C Klersy; R Sebastiani; E Arbustini; F Recusani; L Tavazzi Journal: J Am Coll Cardiol Date: 2001-01 Impact factor: 24.094
Authors: Alice K Jacobs; Jane A Leopold; Eric Bates; Lisa A Mendes; Lynn A Sleeper; Harvey White; Ravin Davidoff; Jean Boland; Sharada Modur; Robert Forman; Judith S Hochman Journal: J Am Coll Cardiol Date: 2003-04-16 Impact factor: 24.094
Authors: François Haddad; Tyler Peterson; Eric Fuh; Kristina T Kudelko; Vinicio de Jesus Perez; Mehdi Skhiri; Randall Vagelos; Ingela Schnittger; Andre Y Denault; David N Rosenthal; Ramona L Doyle; Roham T Zamanian Journal: Circ Heart Fail Date: 2011-09-09 Impact factor: 8.790
Authors: Robert L Kormos; Jeffrey J Teuteberg; Francis D Pagani; Stuart D Russell; Ranjit John; Leslie W Miller; Todd Massey; Carmelo A Milano; Nader Moazami; Kartik S Sundareswaran; David J Farrar Journal: J Thorac Cardiovasc Surg Date: 2010-02-04 Impact factor: 5.209