Abstract
<title>Abstract</title> <p>Approximately one-third of patients with end-stage heart failure present with concomitant biventricular dysfunction. Left ventricular assist device (LVAD) implantation has become a critical salvage therapy for advanced heart failure. However, for patients with severe preoperative right ventricular dysfunction, isolated LVAD implantation carries an extremely high risk of refractory postoperative right heart failure, which significantly increases perioperative mortality. Currently, clinical data regarding the combined use of the domestic Corheart 6 magnetically levitated LVAD and extracorporeal temporary right ventricular assist device (temporary RVAD) for end-stage heart failure of different etiologies remain limited. This retrospective case series analyzed the clinical data of 2 patients with end-stage heart failure at our center. One patient had ischemic cardiomyopathy with multi-vessel coronary artery disease and underwent concomitant coronary artery bypass grafting during surgery; the other had dilated cardiomyopathy complicated with chronic renal insufficiency. Both patients presented with severe preoperative right ventricular dysfunction. After multidisciplinary discussion, all patients underwent Corheart 6 LVAD implantation combined with extracorporeal magnetically levitated temporary RVAD (Extra-VAD; Xinqing Medical, China) under general anesthesia with cardiopulmonary bypass. This paper summarizes the preoperative evaluation, surgical strategies, device parameter settings, and perioperative management experience of the two cases. The results showed that both operations were completed successfully. The temporary RVAD was successfully weaned off on postoperative day 7 and day 4, respectively. Perioperative complications were effectively controlled with symptomatic management, and both patients were discharged in recovered condition on postoperative day 40 and day 50, respectively. At the 2-month postoperative follow-up, both patients had stable hemodynamics, significantly improved cardiac function and quality of life, and no thrombosis, bleeding, or device-related complications. This preliminary case series suggests that concomitant LVAD and temporary RVAD implantation is a safe and feasible option for selected patients with end-stage heart failure of different etiologies complicated with high-risk right ventricular dysfunction. Precise volume management, individualized anticoagulation, and etiology-based perioperative strategies may contribute to improved prognosis. Given the small sample size of only 2 cases, the generalizability of the findings is limited, and further validation in large multicenter cohorts is warranted.</p>