Clinical impact of an upfront RVAD strategy in HeartMate 3 LVAD recipients with severe early right ventricular failure requiring temporary mechanical support

作者：Marta Lorente‐Ros, Mohammad S. Husain, Miguel Pinilla-Vera, Richa Gupta, Rosaria S. Prasad, Blanca Simon Frances, Jiling Chou, Ajay Kadakkal, Alexander Papolos, Benjamin B. Kenigsberg, M.J. Hockstein, Ezequiel Molina, Keki Balsara, Farooq H. Sheikh, Phillip H. Lam · 发表于：JHLT Open · 年份：2025 · DOI：10.1016/j.jhlto.2025.100388 · 被引用次数：7 · 研究领域：Mechanical Circulatory Support Devices、Cardiac Structural Anomalies and Repair、Transplantation: Methods and Outcomes

Background Left ventricular assist device (LVAD) recipients are at risk of developing severe early right ventricular failure (RVF), at times necessitating temporary mechanical support with right ventricular assist device (RVAD). The optimal timing of RVAD implantation in these patients is unclear. The aim of this study is to compare clinical outcomes between upfront RVAD (U-RVAD) and rescue RVAD (R-RVAD) strategies in LVAD recipients with early RVF. Methods In this single-center retrospective cohort study, we included all patients who underwent HeartMate 3 (HM3) LVAD implant and required temporary RVAD support for severe early RVF, defined as <30 days of LVAD implantation, from January 1, 2019 to September 30, 2024. U-RVAD was defined as RVAD use during the index LVAD operation. R-RVAD was defined as RVAD implanted outside of the intra-operative period. Baseline characteristics, peri-operative outcomes, and mortality were compared between patients with U-RVAD and those with R-RVAD. Results During the study period, 402 patients underwent HM3 LVAD implantation, of whom 64 LVAD recipients received temporary RVAD for severe early RVF (mean age 57 years, 27 % female). Of these, 36 received U-RVAD. The incidence of peri-operative atrial arrhythmia and renal replacement therapy were lower in patients who received U-RVAD compared to those who received R-RVAD (p=0.041 and 0.008, respectively). In-hospital and 90-day all-cause mortality occurred in 11 (31%) and 12 (33%) patients receiv...