The Five Pillars of Acute Right Ventricular Heart Failure Therapy: Can We Keep the Pediment in Balance?

Acute right ventricular heart failure (aRHF), a long-neglected aspect of heart disease, has recently gained attention due to an improved understanding of its pathophysiology and the development of tailored therapeutic strategies. The therapeutic approach is now built on several pillars that aim to support the stable clinical condition of the patient, starting with the central pillar of etiological or specific therapy and extending to various aspects related to hemodynamic support, ventilation support, fluid optimization, and, when necessary, advanced resources such as right ventricular assist devices (e.g., extracorporeal membrane oxygenation-ECMO, Impella RP, or ProtekDuo). This five-pillar approach summarizes the different facets of contemporary treatment for aRHF, although some aspects related to their use are still being clarified.