Critical care management of right ventricular failure in pediatric left ventricular assist devices: An advanced cardiac therapies improving outcomes network (ACTION) endorsed statement
Authors
Edon J. Rabinowitz, Washington University School of Medicine in St Louis, Division of Pediatric Critical Care Medicine, Department of Pediatrics and St Louis Children's Hospital, St. Louis, MO.
Nancy Ghanayem, Advocate Health - MidwestFollow
Lydia Wright, Department of Pediatrics, The Heart Center, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
Amee M. Bigelow, Department of Pediatrics, The Heart Center, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
Shilpa V. Govardhan, Rady Children's Hospital, University of California San Diego, San Diego, CA.
Tara M. Neumayr, Washington University School of Medicine in St Louis, Division of Pediatric Critical Care Medicine, Department of Pediatrics and St Louis Children's Hospital, St. Louis, MO.
Tanya Perry, Division of Pediatric Critical Care, Cohen Children's Medical Center of New York, Northwell Health.
Meghna D. Patel, Stanford University School of Medicine, Division of Pediatric Cardiology, Palo Alto, CA.
Robert A. Niebler, Medical College of Wisconsin, Department of Pediatrics and Children's Wisconsin, Herma Heart Institute, Milwaukee, WI.
Kevin P. Engelhardt, Phoenix Children's, Division of Pediatric Critical Care, Phoenix, AZ.
Isaura Diaz, Vanderbilt University Medical Center, Department of Pediatrics, Division of Pediatric Critical Care, Nashville, TN.
Joseph Philip, University of Florida Health, Department of Pediatrics, Division of Pediatric Cardiology, Jacksonville, FL.
Arene Butto, Children's Healthcare of Atlanta, Division of Pediatric Cardiology, Atlanta, GA.
Iki Adachi, Division of Critical Care, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.
David M. Peng, Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI.
David Kwiatkowski, Stanford University School of Medicine, Division of Pediatric Cardiology, Palo Alto, CA.
Sebastian C. Tume, Division of Critical Care, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.
Recommended Citation
Rabinowitz EJ, Ghanayem N, Wright L, et al. Critical care management of right ventricular failure in pediatric left ventricular assist devices: An advanced cardiac therapies improving outcomes network (ACTION) endorsed statement. JHLT Open. 2025;10:100361. Published 2025 Aug 5. doi:10.1016/j.jhlto.2025.100361
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.
