Key result
Graded medical therapy and RVADs effectively manage RV failure affecting ~20% of severe COVID-19 patients.
Why the study?
Right ventricular dysfunction and failure occur in up to 20% of severe COVID-19 patients and correlate with disease severity, but RV failure was largely underdiagnosed early in the pandemic.
Right ventricular failure is a critical complication in up to 20% of severe COVID-19 patients, necessitating a structured, graded approach to medical and mechanical circulatory support.
COVID-19, while primarily recognized for its pulmonary and systemic manifestations, afflicts the cardiovascular system through various abnormalities. Notably, right ventricular (RV) involvement leading to dysfunction and failure is a manifestation seen in up to 20% of severe COVID patients. RV severity correlates with overall COVID severity, serving as a prognostic marker. Data review reveals that RV failure was largely underdiagnosed, particularly early on in the pandemic. The therapy approach for RV failure in patients with COVID should focus on supporting overall RV perfusion pressure, maintaining sinus rhythm, optimizing RV loading conditions and contractility, and addressing anticoagulation and thrombus-related conditions. Beyond medical therapy, cardiac and pulmonary support should be utilized and introduced in a graded, stair-step approach of aggressiveness based on clinical need. This approach is best managed with a care team and defined protocols. Effective devices include right ventricular assistance devices (RVAD), Oxy-RVAD, veno-venous extracorporeal membrane oxygenation, and Impella (Abiomed) devices.
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Marvin J. Slepian (2022) conducted a review in COVID-19 induced right ventricular failure. Right ventricular assist devices and medical therapy was evaluated.
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