On the right side of the heart: Medical and mechanical support of the failing right ventricle

Acute right ventricular failure remains an immensely challenging clinical condition associated with a high mortality rate. In this narrative review, we highlight the pathophysiological mechanisms underlying right ventricular failure and suggest an initial diagnostic approach to this critically ill group of patients. Based on the best available evidence and our cumulative clinical experience as a national cardiothoracic centre, we summarize the basic principles of medical management and mechanical salvage therapy, finalizing with a series of recommendations for the management of right ventricular failure in specific clinical scenarios.