Surgical venous-to–pulmonary artery temporary right ventricular support after durable left ventricular assist device implantation: A single-center experience
TL;DR
T-VAD was the predominant temporary RV support strategy at the authors' institution and was feasible, with favorable observed survival in this descriptive single-center experience, and was associated with significantly greater perioperative resource utilization.
Abstract
Background Postoperative right heart failure (RHF) remains a major complication after durable left ventricular assist device (LVAD) implantation and is associated with substantial morbidity, mortality, and resource utilization. Temporary right-sided mechanical circulatory support strategies are increasingly used for severe RHF, but comparative real-world data remain limited. We evaluated the incidence of postoperative RHF after durable LVAD implantation, its association with early outcomes, and institutional RHF treatment patterns. Methods We performed a retrospective single-center cohort study of 79 consecutive adult patients who underwent durable LVAD implantation at Oklahoma Heart Institute between January 2018 and April 2026. Patients were categorized by the presence or absence of postoperative RHF. The primary analysis compared early postoperative outcomes between RHF and non-RHF groups. Continuous variables were compared using the Wilcoxon rank-sum test and categorical variables using Fisher’s exact test. Results Postoperative RHF occurred in 25 of 79 patients (32%). Baseline demographic and clinical characteristics did not differ significantly between RHF and non-RHF groups. Compared with patients without RHF, those with RHF had longer pre-implant length of stay (14 vs 10 days, p = 0.03), intensive care unit length of stay (21 vs 9 days, p < 0.001), total hospital length of stay (44 vs 34 days, p = 0.01), and post-implant length of stay (25 vs 21 days, p = 0.1). Follow-up status did not differ significantly between groups (p = 0.7). Among the 25 patients with RHF who required mechanical support, treatment strategies included T-VAD in 19 patients, ProtekDuo in 4 patients, and venoarterial extracorporeal membrane oxygenation in 2 patients. Observed follow-up status varied by modality, with 18 of 19 patients (95%) treated with T-VAD alive at last follow-up. Given the small, clinically heterogeneous comparator group, formal between-group comparison was not performed. Conclusions Postoperative RHF occurred in one-third of patients after durable LVAD implantation and was associated with significantly greater perioperative resource utilization. T-VAD was the predominant temporary RV support strategy at our institution and was feasible, with favorable observed survival in this descriptive single-center experience. Differences across support modalities likely reflect distinct clinical phenotypes and indications rather than a device effect and should not be interpreted as comparative evidence.