Echocardiography in Weaning Right Ventricular Mechanical Circulatory Support: Are We Measuring the Right Stuff?
Abstract
Although acute right ventricular (RV) failure is uncommon, it is associated with a poor prognosis and high mortality.
A range of devices now exist to provide temporary mechanical circulatory support (MCS) for the RV in the setting of cardiogenic shock, RV infarction, pulmonary hypertension, post-cardiac surgery, and left ventricular (LV) assist device implantation.
The decision to wean from MCS is dependent on the pertinent assessment of cardiac recovery. Both hemodynamic and echocardiographic parameters are used in conjunction with the evaluation of other major organ function, being cognizant not to view the heart in isolation.
A range of devices now exist to provide temporary mechanical circulatory support (MCS) for the RV in the setting of cardiogenic shock, RV infarction, pulmonary hypertension, post-cardiac surgery, and left ventricular (LV) assist device implantation.
The decision to wean from MCS is dependent on the pertinent assessment of cardiac recovery. Both hemodynamic and echocardiographic parameters are used in conjunction with the evaluation of other major organ function, being cognizant not to view the heart in isolation.
Echocardiographic parameters suggesting LV recovery have been studied extensively, validated in further studies, and have been incorporated into weaning algorithms
Typically, LV ejection fraction (EF) ≥25%, aortic velocity-time integral (VTI) ≥10 cm, and mitral annular systolic velocity ≥6 cm/s, with minimal MCS support, are predictive of a successful wean.
However, robust objective echocardiographic measures of RV recovery remain more elusive.
However, robust objective echocardiographic measures of RV recovery remain more elusive.