This chapter discusses right ventricular assist device (RVAD) therapies. Current RVAD options include the Impella Right Peripheral, the Tandem Heart, the Protek Duo system, and a surgically placed CentriMag RVAD. Important considerations when choosing a device include operator familiarity, the need for an oxygenator, the availability of a surgeon, and specific contraindications such as severe tricuspid regurgitation, an occluded internal jugular vein, or the presence of an inferior vena cava filter. It is important to consider the hemodynamic effects on the left ventricle (LV) after placement of an RVAD. Identifying biventricular failure early is critical when RVAD implantation is considered. RVADs reduce right atrial pressure, increase flow through the pulmonary arteries, and increase LV preload and wedge pressure. This change in preload may worsen LV function and cause pulmonary edema in patients with LV failure. LV assist device revolutions per minute may need to increase after placement of an RVAD to manage increased flow to the LV. Ultimately, assessing changes in oxygen saturation, blood pressure, and echocardiographic indices can guide hemodynamic management of RVAD therapy.
3 Cases of Superior Vena Cava Syndrome Following Percutaneous Right Ventricular Assist Device Placement
