Does Earlier Right Ventricular Assist Device Implant Confer a Survival Advantage?

Biventricular assist device (BiVAD) use has decreased in the pediatric population, partly driven by concerns that survival may be inferior compared with that achieved with isolated left ventricular assist devices (LVAD). We aimed to address whether the timing of right ventricular assist device (RVAD) impacts these outcomes. A retrospective analysis of prospectively collected data of patients who underwent BiVAD implantation between April 2018 and December 2022 and were enrolled in the Advanced Cardiac Therapies Improving Outcomes Network Registry was performed. Baseline clinical and demographic characteristics were compared between the primary (RVAD implanted at the same surgery as LVAD) and delayed (RVAD implanted within 60 days of LVAD) RVAD cohorts, and survival analysis was performed. There were 223 included patients, with 186 (83.4%) having a primary RVAD. Median age at implant was 5.48 years (interquartile range: 1.10, 12.52), 45.7% were female, and 23.3% had congenital heart disease. Primary RVAD patients were more likely to be on dialysis at the time of implantation (p = 0.028) and to have previous sternotomies (p = 0.004). Primary RVAD patients had better 1 year survival (p = 0.023). This suggests that mortality is impacted by RVAD timing in patients requiring BiVAD support. There should be a low threshold for implanting an RVAD during the same surgery as the LVAD in patients displaying signs of right heart failure.