Right ventricular (RV) failure remains a major cause of global morbidity and mortality for patients with advanced heart failure, pulmonary hypertension, or acute myocardial infarction and after major cardiac surgery. Progressive RV dysfunction in these disease states is associated with increased morbidity and mortality. Four primary mechanisms underlie the development of acute RV failure: contractile failure secondary to myocardial ischemia or inflammation caused by myocarditis, volume overload as a result of right-sided valvular insufficiency, volume overload caused by increased venous return or displacement of the interventricular septum toward the left ventricle (LV) and pressure overload resulting from decompensated left-sided heart failure, worsening pulmonary hypertension, or acute pulmonary embolus.
Acute RV failure is a hydraulic problem caused by impaired function of the pump, the valves, or the conduits. Diagnosing acute RV failure remains a major clinical challenge. Physical examination, echocardiographic, and laboratory findings associated with RV failure have been reviewed previously. Medical management of acute RV failure has been extensively reviewed previously and begins with treatment of any reversible cause, which commonly includes coronary revascularization for an acute coronary syndrome or thrombolytic therapy for a pulmonary embolism.
Medical therapy can be divided into 3 major interventions. First, optimization of RV preload with either diuretic therapy or volume expansion is required to maintain cardiac output without worsening venous congestion. For this reason, invasive hemodynamic monitoring with a PA catheter may be useful for patients with RV failure and cardiogenic shock. Second, reducing RV afterload with pulmonary vasodilators may improve RV cardiac output. Third, for patients with persistent hemodynamic instability despite optimization of RV loading conditions, inotropic therapy with either a phosphodiesterase inhibitor or ß1-adrenergic receptor agonist may further improve total cardiac output. For acute RV failure that is refractory to medical therapy, invasive therapeutic options include atrial septostomy, atrial pacing in the setting of bradycardia, durable MCS, and mechanical circulatory support (MCS) devices.
Over the past 2 decades, percutaneously delivered acute mechanical circulatory support pumps specifically designed to support RV failure have been introduced into clinical practice. RV acute mechanical circulatory support now represents an important step in the management of RV failure and provides an opportunity to rapidly stabilize patients with cardiogenic shock involving the RV. As experience with RV devices grows, their role as mechanical therapies for RV failure will depend less on the technical ability to place the device and more on improved algorithms for identifying RV failure, patient monitoring, and weaning protocols for both isolated RV failure and biventricular failure.
The scope of the Research Topic is to provide guidance on the assessment and management of RHF, especially regarding indicating and managing with MCS. A better understanding of the assessment and management to design targeted strategies aimed at improving prognosis are needed. We are interested in manuscripts that describe physiopathology, epidemiology, etiology, diagnosis, pharmacologic use of MCS devices and prognosis.
Although the Research Topic is mainly devoted to clinical studies, well-designed basic studies with clear translational implications will also be considered. We welcome Original Research, Reviews, and Systematic Reviews/meta-analyses.
Right ventricular (RV) failure remains a major cause of global morbidity and mortality for patients with advanced heart failure, pulmonary hypertension, or acute myocardial infarction and after major cardiac surgery. Progressive RV dysfunction in these disease states is associated with increased morbidity and mortality. Four primary mechanisms underlie the development of acute RV failure: contractile failure secondary to myocardial ischemia or inflammation caused by myocarditis, volume overload as a result of right-sided valvular insufficiency, volume overload caused by increased venous return or displacement of the interventricular septum toward the left ventricle (LV) and pressure overload resulting from decompensated left-sided heart failure, worsening pulmonary hypertension, or acute pulmonary embolus.
Acute RV failure is a hydraulic problem caused by impaired function of the pump, the valves, or the conduits. Diagnosing acute RV failure remains a major clinical challenge. Physical examination, echocardiographic, and laboratory findings associated with RV failure have been reviewed previously. Medical management of acute RV failure has been extensively reviewed previously and begins with treatment of any reversible cause, which commonly includes coronary revascularization for an acute coronary syndrome or thrombolytic therapy for a pulmonary embolism.
Medical therapy can be divided into 3 major interventions. First, optimization of RV preload with either diuretic therapy or volume expansion is required to maintain cardiac output without worsening venous congestion. For this reason, invasive hemodynamic monitoring with a PA catheter may be useful for patients with RV failure and cardiogenic shock. Second, reducing RV afterload with pulmonary vasodilators may improve RV cardiac output. Third, for patients with persistent hemodynamic instability despite optimization of RV loading conditions, inotropic therapy with either a phosphodiesterase inhibitor or ß1-adrenergic receptor agonist may further improve total cardiac output. For acute RV failure that is refractory to medical therapy, invasive therapeutic options include atrial septostomy, atrial pacing in the setting of bradycardia, durable MCS, and mechanical circulatory support (MCS) devices.
Over the past 2 decades, percutaneously delivered acute mechanical circulatory support pumps specifically designed to support RV failure have been introduced into clinical practice. RV acute mechanical circulatory support now represents an important step in the management of RV failure and provides an opportunity to rapidly stabilize patients with cardiogenic shock involving the RV. As experience with RV devices grows, their role as mechanical therapies for RV failure will depend less on the technical ability to place the device and more on improved algorithms for identifying RV failure, patient monitoring, and weaning protocols for both isolated RV failure and biventricular failure.
The scope of the Research Topic is to provide guidance on the assessment and management of RHF, especially regarding indicating and managing with MCS. A better understanding of the assessment and management to design targeted strategies aimed at improving prognosis are needed. We are interested in manuscripts that describe physiopathology, epidemiology, etiology, diagnosis, pharmacologic use of MCS devices and prognosis.
Although the Research Topic is mainly devoted to clinical studies, well-designed basic studies with clear translational implications will also be considered. We welcome Original Research, Reviews, and Systematic Reviews/meta-analyses.