Outcomes of Temporary Right Ventricular Assist Device at the Time of Durable Left Ventricular Assist Device Implantation

Patients requiring a right ventricular assist device (RVAD) after durable left ventricular assist device (LVAD) surgery have historically worse outcomes than those with isolated LVADs. Preoperative mechanical circulatory support (MCS) with venoarterial extracorporeal membrane oxygenation (ECMO) or micro-axial pumps complicates right heart assessment by altering loading conditions. We examined 1 year outcomes of patients receiving temporary RVADs at the time of durable LVAD. From February 2017 to August 2025, 102 patients were reviewed. Right ventricular assist device decannulation, ventilator liberation, and intensive care unit (ICU) discharge were assessed using Fine-Gray subdistribution analysis with death as a competing risk; 1 year survival was evaluated by Kaplan-Meier analysis. Analysis included 59 planned, 28 unplanned, and 15 delayed RVADs (45 percutaneous, 57 surgical). One year survival was 64.0 ± 6.5% for planned, 50.2 ± 10.3% for unplanned, and 50.3 ± 13.6% for delayed RVAD. Percutaneous and surgical RVAD survival were 60.1 ± 7.5% and 55.1 ± 7.1%. Preoperative MCS was independently associated with improved survival (hazard ratio [HR]: 0.36, confidence interval [CI]: 0.17-0.83), with micro-axial pump showing the strongest association. Preoperative micro-axial support and planned RVAD were associated with improved 1 year survival after durable LVAD surgery; whether this reflects a causal relationship where the preconditioning of the right ventricle improves postoperative outcomes cannot be determined from this retrospective design.