Limited information exists regarding the effectiveness of oxygenated right ventricular assist devices (OxyRVAD) versus standard right ventricular assist device (RVAD) configurations in patients with acute right ventricular failure (aRVF). We analyzed 345 patients (n = 197 OxyRVAD; n = 148 RVAD) with aRVF from a multicenter registry (PLACE study). Propensity scores were estimated using generalized boosted models. Inverse probability of treatment weighting was applied to balance groups. The primary endpoint was 30 day mortality; secondary endpoints included in-hospital mortality, complications, and successful weaning. Subgroup and interaction analyses were conducted to assess effect modification, particularly by baseline PaO 2 . Oxygenated right ventricular assist device use was not associated with improved 30 day mortality (Hazard Ratio HR: 1.09, 95% confidence interval CI: 0.72–1.65) but was linked to higher risks of thromboembolism (Odds Ratio OR: 1.68, 95% CI: 1.04–2.71), bleeding (OR: 1.53, 95% CI: 1.01–2.39), and renal replacement therapy (OR: 1.61, 95% CI: 1.01–2.61). Subgroup analysis revealed a significant interaction between PaO 2 and treatment group ( p = 0.019), with a mortality benefit observed in patients with PaO 2 of less than 60 mm Hg (HR: 0.67, 95% CI: 0.45–0.99). In non-hypoxemic aRVF patients, OxyRVAD use was associated with increased complications and no survival benefit. These findings support a physiologically stratified approach to temporary RV support and discourage unselected, patient phenotype-oriented OxyRVAD use in the presence of refractory aRVF.
Coco et al. (Mon,) studied this question.