DZHK (German Centre for Heart and Circulatory Research), Partner site Berlin, Berlin, Germany.
Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Heart Fail Rev. 2018 Mar;23(2):157-171. doi: 10.1007/s10741-018-9678-z.
Severe right ventricular (RV) failure is more likely reversible than similar magnitudes of left ventricular (LV) failure and, because reversal of both adaptive remodeling and impaired contractility require most often only short periods of support, the use of temporary RV assist devices (t-RVADs) can be a life-saving therapy option for many patients. Although increased experience with t-RVADs and progresses made in the development of safer devices with lower risk for complications has improved both recovery rate of RV function and patient survival, the mortality of t-RVAD recipients can still be high but it depends mainly on the primary cause of RV failure (RVF), the severity of end-organ dysfunction, and the timing of RVAD implantation, and much less on adverse events and complications related to RVAD implantation, support, or removal. Reduced survival of RVAD recipients should therefore not discourage appropriate application of RVADs because their underuse further reduces the chances for RV recovery and patient survival. The article reviews and discusses the challenges related to the pre-implant and post-implant decision-making processes aiming to get best possible therapeutic results. Special attention is focused on pre-implant RV assessment and prediction of RV improvement during mechanical unloading, patient selection for t-RVAD therapy, assessment of unloading-promoted RV recovery, and prediction of its stability after RVAD removal. Particular consideration is also given to prediction of RVF after LVAD implantation which is usually hampered by the complex interactions between the different risk factors related indirectly or directly to the RV potential for reverse remodeling and functional recovery.
严重的右心室（RV）衰竭比类似程度的左心室（LV）衰竭更有可能是可逆的，并且由于适应性重构和受损收缩性的逆转通常只需要短时间的支持，因此使用临时 RV 辅助装置（t-RVAD）可以成为许多患者的救命治疗选择。尽管 t-RVAD 的使用经验增加以及更安全的设备的开发进展降低了并发症风险，从而提高了 RV 功能的恢复率和患者生存率，但 t-RVAD 接受者的死亡率仍然很高，但主要取决于 RV 衰竭（RVF）的主要原因、终末器官功能障碍的严重程度以及 RVAD 植入的时机，而与 RVAD 植入、支持或移除相关的不良事件和并发症的关系要小得多。因此，RVAD 接受者生存率降低不应阻止 RVAD 的适当应用，因为它们的使用不足会进一步降低 RV 恢复和患者生存的机会。本文回顾和讨论了与植入前和植入后决策过程相关的挑战，旨在获得最佳的治疗效果。特别关注植入前 RV 评估和预测机械卸载期间 RV 的改善、t-RVAD 治疗的患者选择、评估卸载促进的 RV 恢复以及 RVAD 移除后的稳定性预测。还特别考虑了 LVAD 植入后 RVF 的预测，这通常受到与 RV 反向重构和功能恢复潜力间接或直接相关的不同危险因素之间的复杂相互作用的阻碍。
