Baseline PaO2 Modifies the Impact of Oxygenator Use in Temporary Right Ventricular Assist Device Support: A Multicenter Propensity-Weighted Analysis

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 PaO2. 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 PaO2 and treatment group (p = 0.019), with a mortality benefit observed in patients with PaO2 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.