Temporary Mechanical Circulatory Support in Left Ventricular Assist Device Candidates With Right Ventricular Dysfunction: Acuity Without Long-Term Futility

This multicenter cohort study evaluated the impact of preoperative temporary mechanical circulatory support (tMCS) on outcomes in patients with defined right ventricular dysfunction (RVD) undergoing HeartMate 3 left ventricular assist device (LVAD) implantation. Analyzing 201 adults, the authors observed that tMCS utilization correlated with significantly higher baseline clinical acuity, including elevated European Registry for Patients with Mechanical Circulatory Support—Right-Sided Heart Failure (EUROMACS-RHF) scores and profound hemodynamic compromise. Consequently, the tMCS cohort experienced escalated early postoperative morbidity, including prolonged intensive care, increased right ventricular assist device (RVAD) utilization, and higher 90-day mortality. However, conditional landmark analyses demonstrated that among patients surviving the initial 90-day perioperative window, long-term survival was statistically equivalent between groups. The authors conclude that while preoperative tMCS signifies profound early procedural hazard, it does not confer durable long-term mortality risk, positioning it as a physiologic bridge rather than a marker of futility.