Rabinowitz Edon J, Ghanayem Nancy, Wright Lydia, Bigelow Amee M, Govardhan Shilpa V, Neumayr Tara M, Perry Tanya, Patel Meghna D, Niebler Robert A, Engelhardt Kevin P, Diaz Isaura, Philip Joseph, Butto Arene, Adachi Iki, Peng David M, Kwiatkowski David, Tume Sebastian C
Washington University School of Medicine in St Louis, Division of Pediatric Critical Care Medicine, Department of Pediatrics and St Louis Children's Hospital, St. Louis, MO.
University of Chicago, Section of Pediatric Critical Care, Department of Pediatrics, Chicago, IL.
JHLT Open. 2025 Aug 5;10:100361. doi: 10.1016/j.jhlto.2025.100361. eCollection 2025 Nov.
The care of the right ventricle (RV) following left ventricular assist device (LVAD) implantation remains a major clinical challenge, with right ventricular failure (RVF) contributing significantly to morbidity and mortality. While much of the literature focuses on preoperative risk stratification and long-term management, there is limited guidance on the immediate postoperative period from a critical care perspective, particularly in pediatric patients. This review aims to provide practical guidance on the bedside management of the RV in the perioperative period following LVAD implantation in children with biventricular circulation, offering a framework for optimizing RV function and preventing failure. We discuss the pathophysiology of RVF in this setting, highlight key hemodynamic principles, and explore targeted interventions including volume management, inotropic and pulmonary vasodilator support, ventilatory strategies, mechanical circulatory support options, and strategies to mitigate secondary organ dysfunction. By addressing these pediatric-specific critical care considerations, we aim to assist bedside providers in optimizing outcomes for children undergoing LVAD implantation.
左心室辅助装置（LVAD）植入后右心室（RV）的护理仍然是一项重大临床挑战，右心室衰竭（RVF）是发病率和死亡率的重要因素。虽然许多文献关注术前风险分层和长期管理，但从重症监护角度来看，关于术后即刻阶段的指导有限，尤其是在儿科患者中。本综述旨在为双心室循环儿童患者LVAD植入围手术期RV的床边管理提供实用指导，提供优化RV功能和预防衰竭的框架。我们讨论了这种情况下RVF的病理生理学，强调关键血流动力学原理，并探讨针对性干预措施，包括容量管理、正性肌力药和肺血管扩张剂支持、通气策略、机械循环支持选择以及减轻继发性器官功能障碍的策略。通过解决这些儿科特定的重症监护问题，我们旨在帮助床边医护人员优化接受LVAD植入儿童的治疗结果。
