Perioperative right heart failure: treatment.

When right ventricular failure prohibits separation from cardiopulmonary bypass, standard methods of increasing pulmonary blood flow should be employed, including correction of hypoxia and acidosis, volume loading, and inotropic support of the right ventricle. Infusion of pulmonary vasodilators--particularly low-dose nitroprusside--should be used if the pulmonary vascular resistance is elevated. If pulmonary blood flow remains unsatisfactory, systemic intra-aortic balloon counterpulsation should be employed. In refractory cases, right-atrial-to-pulmonary-artery bypass using the Bio-Medicus centrifugal pump is the recommended therapy for those centers that do not have the Pierce-Donachy pneumatic ventricular assist-pump available. For refractory right ventricular failure following the surgical repair of congenital cardiac defects in which the placement of right atrial and pulmonary artery cannulae is not technically feasible, use of high-frequency high-volume ventilation appears to be quite promising. Utilization of pulmonary artery counterpulsation or the creation of an atrial septal defect may also be lifesaving, but is not recommended as the therapy of choice.