LVADs and RV Failure

• Acute RV failure can be seen in up to 10% of patients after LVAD implantation.
• The treatment of RV failure in the LVAD patient consists of the following:
  • Fluids: avoid aggressive fluid administration, as this can displace the septum and impair LVAD function
  • Inotropes: consider early initiation of dobutamine, milrinone, or epinephrine to augment RV function
  • Vasopressors: target a MAP higher than 60 to 70 mmHg to maintain RV perfusion pressure
• If intubated, avoid hypoxia, hypercarbia, high PEEP, and high ventilator pressures.  These can increase pulmonary vascular resistance and further worsen RV function.

References

Sen A, et al. Mechanical circulatory assist devices: a primer for critical care and emergency physicians. Crit Care 2016; 20:153.