Introduction: Right ventricular failure (RVF) is a major cause for increased morbidity and mortality after continuous-flow left ventricular assist device (cf-LVAD) implantation. Patients who are high-risk for developing RVF would benefit from early support via right ventricular assist devices (RVADs) to improve hemodynamics and reduce RVF associated complications. However, current RVF prediction models have limited predictive value. To reduce RVF complications, select institutions have implemented upfront RVAD use in those deemed high-risk with mixed results. In this study, we examined our institutional cohort of high-risk RVF patients who received either emergent or upfront RVADs during LVAD implantation and associated one-year outcomes. Hypothesis: Does providing temporary RVAD support upfront to high-risk patients during LVAD implantation impact associated complications and outcomes. Goals/Aims: To assess one-year clinical outcomes for high-risk patients receiving RVADs during LVAD implantation. Methods: We retrospectively reviewed patients who underwent placement of both LVAD and upfront RVAD at our institution between January 2015 and August 2022. Patients were stratified by the type of RVAD placed (percutaneous vs central) and timing of support (upfront vs emergent). Outcomes were assessed up to one-year post-LVAD implantation. Results/Data: Of the 50 patients reviewed, 36 (72%) underwent upfront RVAD implantations and 14 (28%) underwent emergent RVAD implantations. The upfront cohort consisted of 16 of the total 19 INTERMACS 1 patients, 15 of total 21 INTERMACS 2 patients, 4 of total 9 INTERMACS 3 patients, and 1 of 1 INTERMACS 4 patients. Compared to emergent RVADs, patients who received upfront RVAD had significantly decreased one-year mortality (17.1% vs 50.0%, p=0.031), decreased cerebrovascular accidents (2.8% vs 28.6%, p=0.018), and decreased major bleeding (0% vs 40%, p=0.005). There was no significant difference in the length of stay, arrhythmias, gastrointestinal bleed, hemodialysis requirement, driveline infections or vasoplegia. Conclusion: Patients receiving upfront RVAD at the time of cf-LVAD implantation have improved survival and decreased incidence of cerebrovascular accidents.