The impact of right ventricular function on left ventricular mechanical circulatory support

Left ventricular assist devices (LVADs) being increasingly deployed, both as permanent “destination LVADs”, as bridges to cardiac transplantation, for temporary support to support complex percutaneous coronary interventions, for postoperative support of cardiac surgical patients, or for temporary support of acutely decompensated heart failure. These devices are quite effective for the support of the left ventricle but do rely on native right heart function. In this manuscript we review the unique aspects of right ventricular anatomy and physiology, the assessment of right ventricular function, the impact of right ventricular dysfunction on LVAD performance, and strategies to mitigate this impact. We focus on the most common LVADs, the durable and surgically implanted HeartMate III and the temporary, and usually percutaneously placed, Impella.