Mechanical Circulatory Support for Right Ventricular Primary Graft Dysfunction After Heart Transplant: A Review

• Published in: Clinical transplantation 2025-01, Vol.39 (1), p.e70066-n/a
• Main Authors: Hart, Einar A., Braithwaite, S. A., Hermens, J. A. J., Kraaijeveld, A. O., Ramjankhan, F., Laake, L. W., Oerlemans, M. I. F. J., Szymanski, M. K.
• Format: Article
• Language: English
• Subjects: heart transplant; Heart Transplantation - adverse effects; Heart-Assist Devices - adverse effects; Humans; mechanical circulatory support; primary graft dysfunction; Primary Graft Dysfunction - etiology; Primary Graft Dysfunction - therapy; Review; Ventricular Dysfunction, Right - etiology; Ventricular Dysfunction, Right - therapy
• ISSN: 0902-0063; 1399-0012; 1399-0012
• DOI: 10.1111/ctr.70066

ABSTRACT Primary graft dysfunction (PGD) is the most common cause of early mortality following heart transplantation. Although PGD can affect both ventricles, isolated right ventricular dysfunction (RV‐PGD) is observed in nearly half of PGD patients. RV‐PGD requires specific medical management to support the preload, afterload, and function of the failing RV; however, the use of mechanical circulatory support of the RV (RV‐MCS) might be required when optimal medical therapy is insufficient in preventing forward failure and retrograde venous congestion. While RV‐MCS options provide the opportunity to prevent or to recover from circulatory shock states, MCS is associated with a significant risk of complications. As a result of recent developments in short‐term mechanical support devices, less invasive, percutaneous options for RV‐MCS are available. In this review, we discuss the available devices, their advantages and disadvantages, and reported outcomes in RV‐PGD.