ORIGINAL REPORT Effects of Percutaneous LVAD Support on Right Ventricular Load and Adaptation Jeffrey P. Yourshaw 1 & Prabodh Mishra 2 & M. Christopher Armstrong 2 & Bhavadharini Ramu 1 & Michael L. Craig 1 & Adrian B. Van Bakel 1 & Daniel H. Steinberg 1 & Thomas G. DiSalvo 1 & Ryan J. Tedford 1 & Brian A. Houston 1 Received: 3 December 2017 /Accepted: 12 April 2018 # Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Both operative and hemodynamic mechanisms have been implicated in right heart failure (RHF) following surgical left ventric- ular assist device (LVAD) implantation. We investigated the effects of percutaneous LVAD (pLVAD; Impella®, Abiomed) support on right ventricular (RV) load and adaptation. We reviewed all patients receiving a pLVAD for cardiogenic shock at our institution between July 2014 and April 2017, including only those with pre- and post-pLVAD invasive hemodynamic measurements. Hemodynamic data was recorded immediately prior to pLVAD implantation and up to 96 h post-implantation. Twenty-five patients were included. Cardiac output increased progressively during pLVAD support. PAWP improved early post- pLVAD but did not further improve during continued support. Markers of RV adaptation (right ventricular stroke work index, right atrial pressure (RAP), and RAP to pulmonary artery wedge pressure ratio (RAP:PAWP)) were unchanged acutely implant but progressively improved during continued pLVAD support. Total RV load (pulmonary effective arterial elastance; E A ) and resistive RV load (pulmonary vascular resistance; PVR) both declined progressively. The relationship between RV load and RV adaptation (E A /RAP and E A /RAP:PAWP) was constant throughout. Median vasoactive-inotrope score declined after pLVAD placement and continued to decline throughout support. Percutaneous LVAD support in patients with cardiogenic shock did not acutely worsen RV adaptation, in contrast to previously described hemodynamic effects of surgically implanted durable LVADs. Further, RV load progressively declined during support, and the noted RV adaptation improvement was load-dependent as depicted by constant E A /RA and E A /RAP:PAWP relationships. These findings further implicate the operative changes associated with surgical LVAD implantation in early RHF following durable LVAD. Keywords Temporary mechanical support . Right ventricular adaptation . Right ventricular load . Percutaneous LVAD Introduction Right ventricular failure (RVF) is a known complication of durable, surgically implanted left ventricular assist device (LVAD) implantation. RVF occurs in up to 40% of LVAD patients [1] and is associated with elevated mortality [2]. Studies have been performed to identify clinical, echocardio- graphic, and hemodynamic attributes of those at risk for RVF prior to LVAD implantation and calculate risk scores [3–6]. The pathophysiology of post-LVAD RV failure is complex. Currently, proposed mechanisms include RV injury or geo- metric alteration intraoperatively and the hemodynamic and anatomic effects of the LVAD and its effects on RV afterload and preload [7]. Changes in the contractile pattern of the right ventricle have also been described post-pericardiotomy [8]. Acutely, the RV demonstrates worsened adaptation after sur- gical LVAD implantation despite reduced RV load [9]. Observing the effects on RVadaptation and load of a non- surgical LVAD could help isolate which mechanisms (opera- tive versus mechanical pump function) predominate in the pathophysiology of RVF after durable LVAD. Therefore, our Associate Editor Navin Kumar Kapur oversaw the review of this article Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12265-018-9806-0) contains supplementary material, which is available to authorized users. * Brian A. Houston houstobr@musc.edu 1 Division of Cardiology, Department of Medicine, Medical University of South Carolina, 114 Doughty Street, MSC 592, BM222, Charleston 29425, USA 2 Internal Medicine Residency, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA Journal of Cardiovascular Translational Research https://doi.org/10.1007/s12265-018-9806-0