8.2 Evidence review

Centrifugal versus axial-flow implantable left ventricular assist devices
The currently approved axial-flow and centrifugal LVADs provide safe and effective circulatory support in a population of patients with end-stage HF [138–150].
Centrifugal LVADs may facilitate implantation and offer options for different surgical approaches and strategies [151–154].

Left ventricular assist device versus biventricular assist device: impact of right heart function
A combination of clinical, haemodynamic, echocardiographic and biochemical parameters might be useful to assess right heart function preoperatively and to predict the need for perioperative mechanical RV support (Supplementary Material, Table S3).
Levosimendan prior to LVAD implantation might be used to reduce the risk of right ventricular failure, although evidence is limited [155, 156].
Echocardiographic assessment of RV geometry, contractility and valvular function (Supplementary Material, Table S4) prior to VAD implantation can be useful to evaluate the need for RV support [157–161].
Patients with adequate right heart function who only require LVAD support have better survival rates, lower adverse event rates and superior quality of life than patients requiring BiVAD or TAH support [147, 162–173].
RV failure requiring RVAD support is the most important risk factor for early death in LVAD recipients [170, 174–178].
Temporary RVAD support should be considered in all recipients of an implantable LVAD, even in case of low RV failure risk score (RVAD required in 6–28% of LVAD recipients) [147, 178].
Delayed institution or rescue implantation of RV support further increases the risk of morbidity and mortality compared to early RVAD implantation [147, 168, 169, 171, 179].