Temporary mechanical circulatory support (tMCS) is increasingly used as a bridge to left ventricular assist device (LVAD) implantation in patients with advanced heart failure (HF), particularly those with right ventricular dysfunction (RVD). However, uncertainty remains regarding whether preoperative tMCS independently contributes to adverse outcomes or reflects underlying disease severity.

A retrospective multicenter cohort study published in The Journal of Heart and Lung Transplantation evaluated 201 adults with objectively defined RVD undergoing HeartMate 3 LVAD implantation between 2018 and 2022. RVD was confirmed using echocardiographic criteria, including tricuspid annular plane systolic excursion (TAPSE) <16 mm, and invasive hemodynamics such as central venous pressure (CVP) to pulmonary capillary wedge pressure (PCWP) ratio >0.54 or pulmonary artery pulsatility index (PAPi) <2.0 with cardiac index <2.2 L/min/m². Patients were stratified by preoperative tMCS use, and outcomes included early postoperative morbidity, survival at 1 to 3 years, and conditional survival beyond 30, 90, and 180 days.

Patients receiving tMCS had higher INTERMACS and EUROMACS-RHF scores, more severe hemodynamic compromise, and greater need for ventilatory support. Early postoperative morbidity was increased, including prolonged intensive care unit stay, prolonged mechanical ventilation, and higher right ventricular assist device (RVAD) use. One- and two-year survival were lower in the tMCS group, whereas three-year survival and conditional survival beyond early postoperative periods were similar. Proportional hazards analysis showed that tMCS was associated with earlier, but not sustained, mortality risk.

Overall, tMCS identified patients at higher early perioperative risk, while long-term survival among conditional survivors was comparable. These findings highlight the importance of distinguishing early procedural risk from longer-term prognosis and caution against interpreting tMCS use as evidence of LVAD futility.