Right ventricular dysfunction is a critical predictor of mortality, often progressing to right heart failure, contributing to 3%-9% of heart failure admissions. Acute right heart failure is the primary cause of death in conditions such as right ventricular myocardial infarction and massive pulmonary embolism. Mechanical circulatory support with right ventricular assist devices (RVADs) has become essential in managing both acute and chronic right heart failure. Such devices provide hemodynamic support by assisting the failing right ventricle. This review outlines the mechanisms, clinical indications, and complications of these RVADs. Chest radiography and echocardiography are the primary modalities used for confirming the correct positioning of these devices, and CT is useful for evaluating intra- and extracardiac complications. These imaging modalities are vital for identifying complications and ensuring optimal device performance. As the use of RVADs grows, radiology's role in optimizing outcomes will continue to expand. Keywords: Right Ventricle, Cardiac Assist Devices, Conventional Radiography, CT, Echocardiography Supplemental material is available for this article. © RSNA, 2026.

Left ventricular assist device (LVAD) chronic inflow suck-down: a case report demonstrating the need for retrospective cardiac computed tomography angiography for LVAD assessment.

In an era of improved outcomes and expanding use of left ventricular assist devices (LVADs) among patients with end-stage heart failure, anesthesiologists increasingly encounter such patients presenting for noncardiac surgery. This review synthesizes current advances in the perioperative and anesthetic management of patients with LVADs in the noncardiac surgical setting, providing actionable, evidence-based recommendations. Although a range of durable mechanical circulatory support options currently exist for patients, third-generation continuous-flow LVADs are now the predominant devices, demonstrating improved survival but posing unique perioperative challenges. A multidisciplinary approach - including heart failure and device specialists - is essential for preoperative assessment, medical management, and optimal care coordination in anticipation of the surgical admission. Intraoperative care requires nuanced monitoring strategies and vigilance for complications such as suction events or right ventricular failure; the anesthetic plan should carefully consider preload/afterload dependency and anticoagulation. Postoperative management includes tailored hemodynamic, device, and anticoagulation strategies to minimize complications. Optimal outcomes for LVAD patients undergoing noncardiac surgery require multidisciplinary planning, device-specific knowledge, and meticulous management of anticoagulation, hemodynamics, and right ventricular function. Future research should standardize protocols for perioperative LVAD management in nonspecialist centers.

Destination Ventricular Assist Device: A Single-Centre Experience With a Newly Approved Therapy for Advanced Heart Failure.

Heart failure affects over 1.2 million Polish citizens. Although the current implantation rate of 3.3 left ventricular assist devices (LVADs) per million population remains below the European average, if the upward trend is maintained, Poland may soon reach the level of mid-range European countries (4-6 LVADs per million). The national registry aimed to provide systematic oversight of the Polish LVAD population along with treatment outcomes. A prospective multicenter observational registry of all consecutive LVAD patients undergoing LVAD implantation between January 1, 2022 and December 31, 2024. Data were compared to the Society of Thoracic Surgeons (STS) registry. From January 2022 to December 2024, 266 adult patients received LVAD in Poland. There has been approximately 40% year-to-year increase in LVAD utilization. The cohort consisted predominantly of men (96.1%) with a median age of 57.76 (49.80-64.53) years. In contrast, in the STS-Intermacs registry women represented 21.9%. Ischemic cardiomyopathy was markedly more common (60.8%) in POL-LVAD registry on contrary to non-ischemic on STS registry (54.2%). Polish recipients presented with a significantly lower clinical acuity, with Intermacs profiles 1-3 accounting only for 55%-68% of implants, compared with nearly 90% in the STS cohort. Moreover, unlike the STS registry - where destination therapy accounted for over 80% of implants-the Polish cohort was dominated with a bridge-to-transplantation strategy (72%). During median follow-up of 471 days (interquartile range 283-729) 69 patients died, and 26 underwent heart transplantation, which translates into an actual probability of survival of 81%, 71% and 64% at 1, 2 and 3 years, respectively, and is comparable to STS-Intermacs registry. Age was the main survival discriminator in the Polish cohort. This is the first report of the Polish National Mechanical Circulatory Support Registry. The POL-LVAD registry shows a dynamic growth of LVAD therapy in Poland, with survival outcomes comparable to the STS registry.

Reply to Letter: "Bridging in Left Ventricular Assist Device Patients".

Hidden Danger of Microaxial Flow Pumps: Five Cases of Aortic and Innominate Mural Thrombi.

Individuals with hypoplastic left heart syndrome (HLHS) have an underdeveloped left ventricle and require surgery to reconfigure blood flow for survival. Here we profiled the HLHS right-ventricular microenvironment by single-nucleus RNA sequencing and spatial transcriptomics at birth (before heart failure), after surgery with heart failure and after ventricular assist device (VAD) unloading (reduced hypoxia and volume overload). We show that HLHS cardiomyocytes, both within the heart and when derived from induced pluripotent stem cells, are intrinsically senescent. The HLHS myocardium contained a senescent microvascular niche with endothelial cells, pericytes and YAP-high fibroblasts, consistent with hypoxic and mechanical stress. This senescent niche is similar to adult myocardial infarction but not pediatric dilated cardiomyopathy with heart failure, pointing to a prominent role of hypoxia in senescence. The microvascular senescent niche was improved by VAD, providing insight into the potential to reverse cardiac cell states that lead to heart failure.

Aortic insufficiency (AI) that develops during long-term support with continuous-flow left ventricular assist devices (LVADs) remains a significant clinical problem. Abnormal flow patterns and altered wall shear stress (WSS) on the aortic valve are believed to contribute to leaflet remodeling, yet the hemodynamic influence of outflow graft orientation in patient-specific anatomies is not fully understood. This study investigated how different outflow graft angles affect aortic valve WSS and coronary perfusion using computational fluid dynamics (CFD). Three LVAD recipients who underwent preoperative ECG-gated coronary CT were retrospectively analyzed. Patient-specific geometries of the ascending aorta, aortic root, and coronary arteries were reconstructed. A cylindrical outflow graft was virtually anastomosed 25mm above the sino-tubular junction, and three inclination angles (30°, 60°, 90°) were modeled with a fixed azimuthal angle of 90°. CFD simulations were performed under constant LVAD inflow (5.0L/min) and uniform outlet pressure conditions. WSS on the aortic valve cusps and coronary flow rates were evaluated after achieving quasi-steady flow. Increasing outflow graft angle resulted in higher WSS on the ascending aortic wall opposite the anastomosis and consistently elevated WSS on the left coronary cusp. In some cases, the non-coronary cusp also showed localized WSS increases. Coronary flow decreased with shallower graft angles, with left coronary artery flow approximately halved at 30° compared with 90°, while right coronary flow exhibited a smaller reduction. Outflow graft angle substantially affects aortic valve WSS distribution and coronary perfusion. Steeper angles increase leaflet WSS, whereas shallower angles reduce coronary flow. Patient-specific CFD simulations may aid in optimizing graft positioning and reducing the risk of AI progression in LVAD patients.

Accurate patient understanding of prognosis is essential for informed decision-making to pursue therapies for advanced heart failure (HF). To evaluate (1) patient characteristics associated with overestimating survival with HF and (2) whether overestimation is associated with mortality. This prospective cohort study was an exploratory secondary analysis of data from the multicenter US Registry Evaluation of Vital Information for Ventricular Assist Devices (VADs) in Ambulatory Life (REVIVAL) study. Participants were high-risk ambulatory patients with HF with reduced ejection fraction enrolled from July 2015 to June 2016. Data were analyzed from December 1, 2024, to December 16, 2025. Patient characteristics (eg, age) and estimation index (EI), defined as the ratio of patient-estimated life expectancy to Seattle Heart Failure Model (SHFM)-estimated mean survival (EI <0.5, discordantly pessimistic; 0.5 to <1.5, concordant; and ≥1.5, discordantly optimistic). Primary outcomes were EI and 2-year all-cause mortality. Factors associated with EI were estimated using ordered logistic regression. Association between EI and mortality was assessed using a cause-specific Cox proportional hazards regression model with VAD and heart transplant as censoring events. A total of 296 high-risk, ambulatory patients with chronic HF were included; 223 (75.3%) were male, and mean (SD) age was 60.1 (11.5) years. The median SHFM-estimated survival was 8.2 years (IQR, 5.1-12.1 years), and median patient-estimated life expectancy was 7.0 years (IQR, 5.0-10.0 years). In all, 98 patients (33.1%) were discordantly optimistic. Increasing EI was associated with increased mortality in the univariable model, which was attenuated with multivariable adjustment (adjusted hazard ratio [AHR] for concordant optimism, 1.21 [95% CI, 0.49-2.99] and for discordant optimism, 2.23 [95% CI, 0.94-5.33] vs discordant pessimism). Compared with discordantly pessimistic or concordantly optimistic estimates (EI <1.5), discordant optimism was associated with increased hazard of 2-year mortality (AHR, 1.98; 95% CI, 1.04-3.77) but a similar hazard for a VAD or heart transplant compared with discordant pessimism (HR, 1.24; 95% CI, 0.64-2.41) in a post hoc analysis. In this cohort study, discordant optimism regarding life expectancy compared with model estimates was common and associated with mortality that was not due to a lower probability of receiving a heart transplant or VAD. The findings suggest clinicians should objectively evaluate HF risk when considering advanced therapies, rather than relying primarily on patient-reported symptoms.

The safety and efficacy of direct oral anticoagulants (DOACs) in patients with left ventricular assist devices (LVADs) remain uncertain because of limited comparative data with warfarin. Are DOACs a safe and effective alternative to warfarin in patients with durable LVADs? A retrospective cohort study using the TriNetX database was conducted. Adults with LVADs prescribed DOACs or warfarin were included. Propensity score matching (1:1) was performed to balance baseline characteristics. The primary outcome was all-cause mortality. Secondary outcomes included thromboembolic events, major bleeding, and blood transfusion requirements. Among 3726 patients with LVAD, 79 received DOACs and 3647 received warfarin. After matching, 77 patients remained in each group. At 5 years, all-cause mortality was significantly lower in the DOAC group compared to warfarin (13% vs. 30%, P < 0.001). Rates of thromboembolism and major bleeding were similar, while blood transfusion needs were lower in the DOAC group (13% vs. 22.1%). In this multicenter cohort, DOACs were associated with improved long-term survival and comparable safety outcomes relative to warfarin in LVAD patients. These findings suggest DOACs may be a viable alternative, but larger prospective studies are warranted.

The accessibility of left ventricular assist device (LVAD) therapy is acrucial factor in the survival and quality of life of patients suffering from advanced heart failure. However, there is alack of clarity regarding the utilization of this therapy across regions in the Netherlands as well as whether any disparities exist based on socioeconomic status (SES). This study aimed to determine the utilization of LVAD therapy at aregional level using administrative data and to identify potential disparities based on SES by comparing postal code data to demographic governmental data. All patients aged 16 or older who underwent aprimary LVAD implantation between 2015 and 2024 were included. The data was visualized with aheatmap using Python. Atotal of 710 patients received an LVAD during the study period. LVAD utilization was lower in the southernmost regions compared to the northernmost regions and varied in the central regions. An ANOVA test between SES groups did not show significant differences in LVAD utilization (p = 0.20). The findings of this study indicate that there are notable variations in the utilization of LVAD therapy across different geographical regions in the Netherlands. Nevertheless, no differences in LVAD use were found between areas with different SES categories. Future research should focus on identifying the underlying factors associated with referral for advanced heart failure therapies to ensure equitable access to LVAD therapy.

Background: In adult patients with transposition of the great arteries (TGA) and systemic right ventricle (sRV), the use of ventricular assist devices (VADs) is uncommon. Methods: We conducted a systematic review of published studies to examine the indications, hemodynamic effects, and outcomes of VADs in this patient population. We reviewed English-language literature for case reports, case series, and reviews that included individual patient data, such as demographics, hemodynamic parameters, types of implanted VADs, and outcomes. Results: We identified 107 patients, 76% (81/107) males, mean age 40.2 ± 10.6 at the time of implantation, 38.3% (41/107) with left TGA (L-TGA), and 61.7% (66/107) with dextro-TGA (D-TGA). The VAD support resulted in hemodynamic improvement, including a decrease in the mean pulmonary arterial pressure (45 ± 15 mm Hg before implantation to 25 ± 9.3 mm Hg afterwards, P < .001), pulmonary vascular resistance (6.3 ± 4.9 Wood units (WU) to 2.4 ± 1.35 WU, P < .001), right atrial pressure (16.4 ± 7.3 mm Hg to 9.5 ± 3.7 mm Hg, P = .009), and pulmonary capillary wedge pressure (25.45 ± 7.12 mm Hg to 14.25 ± 5.6 mm Hg, P < .001). The cardiac index increased from 2.0 ± 0.5 L/min/m² to 2.8 ± 0.6 L/min/m² (P = .004). The 1-year survival rate was 80.5%. Eventually, 31 (29%) underwent heart transplantation, and 48 (54%) remained on VAD at the time of publication. Conclusions: Durable VADs provide hemodynamic improvement and excellent survival in adults with a systemic right ventricle. Expanding the use of VADs for this patient population would be justified.

Meeting report: Expanding access to advanced cardiac therapies, including ventricular assist devices (VADs) and heart transplantation in muscular dystrophy.

We describe a modified Park's stitch technique incorporating systematic free margin alignment to achieve complete elimination of aortic regurgitation in patients with a left ventricular assist device. The technique involves a two-step approach: first, free margin alignment of all three cusps using single interrupted 6-0 polypropylene sutures placed at the nodules of Arantius to achieve precise coaptation, followed by conventional Park's stitch using mattress sutures with autologous pericardial pledgets for central closure. The alignment sutures remain in place to provide reinforcement. This modification addresses the central redundancy created by prolapsing or elongated cusps while maintaining the theoretical advantages of Park's stitch. In six consecutive patients (mean age, 56.5 years; 66.7% destination therapy), complete elimination of aortic insufficiency was immediately achieved with a median cross-clamp time of 30.5 min (interquartile range, 26.8-41.3 min). At follow-up (median, 8 months), five of the six patients had maintained zero regurgitation, while the remaining patient had developed only trivial regurgitation. This systematic approach to free margin alignment before Park's stitch may offer improved durability compared with conventional techniques, particularly for destination therapy patients requiring extended support.

Biventricular assist for failing Fontan circulation remains challenging. Because fenestration effectively reduces stressed blood volume and central venous pressure in Fontan patients with increased pulmonary vascular resistance (PVR), systemic ventricular assist device (VAD) combined with fenestration may improve hemodynamics in failing Fontan patients with increased PVR who would require biventricular assist. To validate this hypothesis, we performed a computational hemodynamic simulation of the failing Fontan circulation using a lumped parameter model. We compared hemodynamic variables between the models with and without fenestration while the PVR index was increased sequentially from 3.01 to 6.81 Wood Units m2. Following VAD initiation and stressed blood volume reduction, central venous pressure was maintained at a lower level in the fenestration models. This positive effect was greater in the model with larger fenestration diameter. However, excessive fenestration caused significant desaturation. In failing Fontan circulation with elevated PVR, systemic VAD combined with fenestration significantly improved hemodynamics.

iDECIDE-VAD-PEDIATRIC : Development of a Decision Aid to Assist Children and Their Caregivers When Considering a Ventricular Assist Device.

Pulmonary atresia with intact ventricular septum (PA-IVS) and myocardial dysfunction is a challenging entity to manage. Presented is a patient with PA-IVS who developed myocardial dysfunction and heart failure following an episode of periprocedural hypotension. He was successfully treated with a single ventricle assist device (SVAD) placed without cardiopulmonary bypass and a ductal stent as a bridge to donation after circulatory death heart transplant. This report describes the technique of SVAD placement without cardiopulmonary bypass.

Ex-vivo heart perfusion attenuates early post-transplant risk after prolonged agonal period in DCD heart transplantation.

D. Mukherjee, A. K. Ghosh, A. Bandyopadhyay, et al., "Melatonin Protects Against Isoproterenol-Induced Alterations in Cardiac Mitochondrial Energy-Metabolizing Enzymes, Apoptotic Proteins, and Assists in Complete Recovery From Myocardial Injury in Rats," Journal of Pineal Research 53, no. 2 (2012): 166-179, https://doi.org/10.1111/j.1600-079X.2012.00984.x. This Expression of Concern is for the above article, published online on 20 February 2012 in Wiley Online Library (wileyonlinelibrary.com), and has been issued by agreement between the journal Editor-in-Chief, Gianluca Tosini; and John Wiley & Sons Ltd. A third party raised concerns that the beta-actin control bands in Figures 3A, 4A, 4B, 5A, 5B, 6A, 6B, 7A, and 7B were duplicates and had also been used in an earlier article by most of the same authors [Mukherjee et al. 2010 (https://doi.org/10.1111/j.1600-079X.2010.00749.x)]. The authors responded to an inquiry by the publisher and stated that the studies reported in both articles were part of a single experimental project conducted between 2008 and 2009, which used identical sample sets processed under uniform conditions. Most of the original data were no longer available. As such, the publisher is not able to validate the data related to these concerns. Additionally, this article did not adequately indicate that both articles derived from the same experimental procedure and did not declare the re-use of beta-actin control bands. This Expression of Concern has been published in order to inform and alert readers about these concerns. The authors were informed of this Expression of Concern.