Right Ventricular-Pulmonary Artery Cannulation in Right Ventricular Failure: An Updated Narrative Review

Right ventricular (RV) failure is a life-threatening condition contributing to morbidity and mortality in several pathological conditions, particularly in postcardiotomy shock, advanced heart failure, pulmonary embolism, and severe respiratory disease. Temporary mechanical circulatory support has gained increasing attention in refractory conditions, with dual-lumen cannulation strategies specifically designed to facilitate such a support modality, decompress the right atrium or ventricle while preserving antegrade pulmonary blood flow and allowing, in case of need, concomitant RV and respiratory support.

A narrative review was conducted through PubMed, identifying English-language, peer-reviewed articles published between January 2011 and September 2025. The search combined the term "dual lumen pulmonary artery cannula" with related keywords including "pulmonary artery cannulation", "right atrium to pulmonary artery cannulation", "percutaneous right ventricular assist", "temporary RVAD", "oxygenated RVAD", and "right-sided mechanical circulatory support". Eligible studies included case reports, series, cohort studies, and reviews. Structured institutional resources were also evaluated to complement evidence with practical insights.

Twenty-one publications were identified, of which 13 met the inclusion criteria. Reports consistently highlighted the rationale for RV unloading, clinical indications across postcardiotomy shock, LVAD-related dysfunction, pulmonary embolism, and ARDS, and described standardized insertion through the right internal jugular vein with imaging guidance. Complications included cannula malposition, thromboembolism, bleeding, and infection, while support durations typically ranged from 7 to 14 days, although its incidence is lower with jugular access compared with femoral approaches and open chest procedures. Weaning rates ranged between 40% and 70% of cases, with early initiation of support associated with improved survival.

Dual-lumen right atrium/ventricle-to-pulmonary artery cannulation represents a feasible and physiologically advantageous option for temporary isolated RV or concomitant RV and respiratory support. Current evidence, however, is limited to small observational studies, underscoring the need for multicenter registries, uniform nomenclature, and prospective trials to establish standardized protocols and clarify its role relative to alternative right-sided support strategies.