Critical care management of right ventricular failure in pediatric left ventricular assist devices: An advanced cardiac therapies improving outcomes network (ACTION) endorsed statement

Abstract

The care of the right ventricle (RV) following left ventricular assist device (LVAD) implantation remains a major clinical challenge, with right ventricular failure (RVF) contributing significantly to morbidity and mortality. While much of the literature focuses on preoperative risk stratification and long-term management, there is limited guidance on the immediate postoperative period from a critical care perspective, particularly in pediatric patients. This review aims to provide practical guidance on the bedside management of the RV in the perioperative period following LVAD implantation in children with biventricular circulation, offering a framework for optimizing RV function and preventing failure. We discuss the pathophysiology of RVF in this setting, highlight key hemodynamic principles, and explore targeted interventions including volume management, inotropic and pulmonary vasodilator support, ventilatory strategies, mechanical circulatory support options, and strategies to mitigate secondary organ dysfunction. By addressing these pediatric-specific critical care considerations, we aim to assist bedside providers in optimizing outcomes for children undergoing LVAD implantation.