Early Right Heart Failure After Left Ventricular Assist Device Implantation: A Narrative Review of Definitions, Risk Prediction, and Management

Early right heart failure (RHF) remains common after left ventricular assist device (LVAD) implantation and is associated with substantial morbidity and mortality. Definition and time window determine reported incidence and complicate risk-model comparison. Established risk models perform differently across cohorts and device eras, and temporary support should be matched to the dominant physiology. LV unloading alters venous return, septal geometry, and right ventricular (RV) loading, whereas perioperative stress exposes limited RV reserve. No single clinical, imaging, or hemodynamic measure reliably predicts early RHF, and existing scores perform variably on external validation. Dynamic hemodynamic assessment adds information about RV reserve and warrants prospective threshold validation. Management begins by addressing reversible causes and optimizing LVAD support. When temporary mechanical support is required, RV-specific bypass restores pulmonary forward flow, an oxygenated right atrial-to-pulmonary arterial RVAD adds gas exchange, and venoarterial extracorporeal membrane oxygenation provides broader rescue for combined circulatory and respiratory failure. Comparative evidence on timing and configuration remains observational.