Right Ventricular Dysfunction: Lessons Learned From Mechanical Circulatory Assist Devices

Congestive heart failure represents a disease process of epidemic proportions in the United States, with 900,000 annual hospitalizations for New York Heart Association class III to IV symptoms. The inexorable deterioration of this group of patients has, until recently, been delayed by pharmacotherapy and by the use of automated implantable cardioverter defibrillators and cardiac resynchronization therapy. The authors propose that a major component of the downhill course of New York Heart Association class IV left heart failure is secondary to right heart failure and present the major predictors of right ventricular dysfunction. This, together with the limited availability of heart transplant donors, has led to the development of the left ventricular assist devices and the total artificial heart. Contrasting and comparing these devices have permitted insight into the importance of right ventricular function in the pathophysiology of heart failure, especially in the decision to proceed with left ventricular assist device placement, which is limited by right heart dysfunction or biventricular replacement with the total artificial heart.