Temporary mechanical circulatory support in left ventricular assist device candidates with right ventricular...

Temporary mechanical circulatory support (tMCS) is increasingly used as a bridge to durable left ventricular assist device (LVAD) implantation in patients with advanced heart failure, particularly those with right ventricular dysfunction (RVD). RVD at the time of LVAD implantation predicts early morbidity and mortality, and preoperative tMCS has been associated with inferior survival in registry analyses. However, whether tMCS independently contributes to long-term risk or simply identifies high-acuity patients remains unclear.

We conducted a retrospective, multicenter cohort study of 201 adult patients with objectively defined RVD undergoing HeartMate 3 implantation between 2018 and 2022. RVD was confirmed by echocardiography (TAPSE <16 mm and/or qualitative RV dysfunction) and invasive hemodynamics (CVP/PCWP >0.54 and/or PAPi <2.0 with cardiac index <2.2L/min/m²). Patients were stratified by preoperative tMCS use. Outcomes included early postoperative morbidity, survival at 1 to 3 years, and conditional survival after 30-, 90-, and 180-days.

tMCS patients had higher INTERMACS and EUROMACS-RHF scores, more severe hemodynamic compromise, and greater ventilatory support. They experienced increased early morbidity, including prolonged ICU stay, mechanical ventilation, and higher RVAD utilization. One- and 2-year survival was lower in tMCS patients, but 3-year survival and conditional survival beyond 30 to 180 days were similar between groups. Proportional hazards analysis showed that tMCS was independently associated with earlier but not longer-term mortality.

In LVAD recipients with defined RVD, preoperative tMCS identifies patients at heightened early perioperative risk but does not confer durable mortality risk among conditional survivors. These findings underscore the importance of separating early procedural hazard from durable prognosis and caution against interpreting tMCS use as evidence of LVAD futility.