Alternativas terapéuticas actuales en la insuficiencia del ventrículo derecho tras cardiotomía

Severe postcardiotomy right ventricular failure is a complication of cardiac surgery that can occur in both adult and pediatric patients. Right ventricular failure that is not due to serious, left-sided heart failure can be dealt with using specific therapeutic strategies. Conventional management of right ventricular failure may involve: treating the triggering event, whether cardiac or extracardiac; optimizing right ventricular preload; using an inotropic or inodilator agent; modulating pulmonary vascular resistance; and employing specific forms of mechanical ventilation designed to minimize the effect of positive-pressure ventilation on right ventricular afterload. Also available are advanced or rescue treatments, such as surgery for selected patients and mechanical circulatory support for refractory cases. The various therapeutic alternatives can be used either alone or in combination, but they must always be tailored to the individual patient.