Interventional strategies to unload the right ventricle: a systematic review.

Abstract

Introduction: The function of the right ventricle (RV) is dependent on preload, end-systolic elastance (afterload), and intrinsic RV contractility. RV dysfunction comprises dilatation and hypertrophy, leading to RV failure and commonly death despite advances in medical treatments. This systematic review summarizes current and future interventional treatments to mechanically unload the RV. First, this review focuses on targeting pulmonary vascular afterload by addressing 1. Catheter-directed treatment for acute pulmonary embolism, 2. Balloon Pulmonary Angioplasty for chronic thromboembolic pulmonary hypertension, and 3. Pulmonary Artery Denervation for pulmonary hypertension. Second, mechanical support systems for enhancing RV contractility and interventions targeting tricuspid regurgitation as a cause of RV failure are discussed.

Methods: On 2nd December 2024, a systematic search for publications between 2022 and 2025 was performed, using MEDLINE, EMBASE, Cochrane, and SCOPUS. The primary outcome was an improvement in hemodynamic measurements. Secondary outcomes included in-hospital mortality and complications. Meta-analyses, randomized controlled trials and for newer devices, observational studies and case series were included.

Results: Of 32,852 screened studies, 80 were included. All treatments demonstrated various degrees of RV unloading.

Conclusion: Novel treatments directed at mechanical RV unloading may improve survival, but further research is needed to examine long-term effects.

Prospero registration: CRD42024616310.