Marzec Lucas N, Ambardekar Amrut V
1University of Colorado, Aurora, CO, USA.
Semin Cardiothorac Vasc Anesth. 2013 Dec;17(4):249-61. doi: 10.1177/1089253213488246. Epub 2013 May 2.
Right ventricular (RV) failure continues to be a major cause of morbidity and mortality after left ventricular assist device (LVAD) implantation. Preoperative evaluation of RV function with a variety of clinical, laboratory, echocardiographic, and hemodynamic variables is essential to ensure appropriate patient selection for LVAD therapy but remains imperfect. Therefore, clinicians involved in the care of these patients need to be prepared to manage RV failure after LVAD placement. Perioperative management of RV failure after LVAD implantation requires minimization of intraoperative RV ischemia, maintenance of appropriate filling pressure, supportive therapy with pulmonary vasodilators and inotropes, and surgical interventions such as RV assist devices in select cases. This article reviews the incidence of RV failure with LVAD implantation, preoperative predictors of RV failure, and perioperative management strategies.
右心室（RV）衰竭仍然是左心室辅助装置（LVAD）植入术后发病和死亡的主要原因。使用各种临床、实验室、超声心动图和血流动力学变量对RV功能进行术前评估对于确保LVAD治疗的合适患者选择至关重要，但仍不完善。因此，参与这些患者护理的临床医生需要准备好处理LVAD植入后的RV衰竭。LVAD植入术后RV衰竭的围手术期管理需要尽量减少术中RV缺血、维持适当的充盈压、使用肺血管扩张剂和正性肌力药物进行支持治疗，以及在某些情况下进行手术干预，如RV辅助装置。本文综述了LVAD植入术后RV衰竭的发生率、RV衰竭的术前预测因素以及围手术期管理策略。
