University of Toronto, Staff Anaesthesiologist, Toronto General Hospital, Department of Anaesthesia and Pain Management, 200 Elizabeth Street, EN 3-442, Toronto, ON, Canada M5G 2C4.
Best Pract Res Clin Anaesthesiol. 2012 Jun;26(2):217-29. doi: 10.1016/j.bpa.2012.03.006.
Right ventricular failure (RVF) complicates 20-50% of left ventricular assist device (LVAD) implantation cases and contributes to increased postoperative morbidity and mortality. Normal LVAD function alters the highly compliant right ventricular (RV) physiology, which may unmask RVF. Risk scores for predicting RVF post-LVAD incorporate multiple risk factors but have not been prospectively validated. Prevention of RVF consists of optimising RV function by modifying RV preload and afterload, providing adequate intra-operative RV protection and minimising blood transfusions. Treatment of RVF relies on inotropic support, decreasing pulmonary vascular resistance and adjusting LVAD flows to minimise distortion of RV geometry. RVAD insertion is a last recourse when RVF is refractory to medical treatment.
右心衰竭（RVF）是左心室辅助装置（LVAD）植入病例的 20-50%的并发症，增加了术后发病率和死亡率。正常的 LVAD 功能改变了高顺应性的右心室（RV）生理，这可能会暴露出 RVF。预测 LVAD 后 RVF 的风险评分包含多个风险因素，但尚未经过前瞻性验证。预防 RVF 包括通过改变 RV 前负荷和后负荷来优化 RV 功能，提供充分的术中 RV 保护和尽量减少输血。RVF 的治疗依赖于正性肌力支持、降低肺血管阻力和调整 LVAD 流量，以尽量减少 RV 几何形状的扭曲。当 RVF 对药物治疗无反应时，插入 RVAD 是最后的手段。
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