Temporary Right Ventricular Mechanical Circulatory Support Devices in Acute Right Ventricular Failure and Cardiogenic...

Evidence for temporary right ventricular assist devices (tRVADs) is fragmented. We characterized outcomes among adults receiving temporary support for acute right ventricular (RV) failure or RV-predominant cardiogenic shock.

MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov were searched from inception to June 2026. Arm-level outcome proportions were pooled on the logit scale using three-level random-effects models, with arms nested within studies. Device-stratified estimates, meta-regression, and sensitivity analyses were examined.

We included 106 studies (119 device arms; 4653 patients), including 57 conference-abstract studies (53.8%). Concurrent left-sided support was reported in 85.8% of patients with available data; post-LVAD RV failure predominated in 47.5% of arms. Separately pooled survival to discharge was 60.4% (95% CI 56.0-64.7; 63 arms), successful weaning 60.6% (54.8-66.2; 68 arms), and 30-day mortality 30.1% (24.1-36.9; 31 arms). The survival prediction interval was wide (34.4%-81.6%). Pooled bleeding, renal complications (acute kidney injury and/or renal replacement therapy, as reported), and stroke were 36.5%, 46.6%, and 14.5%, respectively. Device-stratified estimates were vulnerable to confounding. No meta-regression association remained significant after multiplicity correction.

These descriptive estimates characterize selected, heterogeneous treated cohorts, predominantly receiving left-sided or biventricular support; they do not establish treatment benefit or comparative device effectiveness. Complication rates were high. Applicability to isolated primary RV shock is limited. Standardized prospective data are needed to inform patient selection, timing, and device strategy.

PROSPERO registration number: CRD420261406088.