The Diagnosis and Treatment of Postoperative Right Heart Failure

Background: Acute right heart failure is a life-threatening condition that can arise postoperatively. The options for symptomatic treatment have been markedly expanded in recent years through the introduction of percutaneously implantable mechanical cardiac support systems. Methods: This review is based on publications retrieved by a selective literature search in PubMed as well as on guidelines from Germany and abroad. Results: The diagnostic evaluation of right heart failure is chiefly based on echocardiography and pulmonary arterial catheteri-zation and is intended to lead to immediate treatment. Alongside treatment of the cause of the condition, supportive manage-ment is crucial to patient survival. A variety of ventilation strategies depending on the situation, catecholamine therapies, inhaled selective pulmonary vasodilators, and cardiac support systems are available for this purpose. The in-hospital mortality of postoperative right heart failure is 5-17 %. The results of the use of cardiac support systems reported in case series are dis-appointing, but nonetheless good compared to what these critically ill patients would face without such treatment. In one observational study, the 30-day survival rate was 73.3%. Conclusion: Survival is aided by the rapid recognition of right heart failure, targeted multidisciplinary treatment, and contact with an extracorporeal life support (ECLS) center for additional supportive treatment measures. Further studies on the use of phar-macological and mechanical cardiac support systems must be carried out to provide stronger evidence on which treatment recommendations can be based.