Right ventricular dysfunction (RVD) remains a significant contributor to mortality and morbidity, posing a persistent challenge in the management of advanced heart failure patients undergoing evaluation for long term mechanical circulatory support (MCS) devices and definitive treatment with heart transplantation. Furthermore, there has been a steep rise in short-term mortality rates in advanced heart failure patients requiring MCS with co-existing RVD.1, 2, 3

Intra-aortic balloon pumps (IABP) have been routinely utilized in previous decades. However, in recent years, there has been a declining trend in its use, especially for cardiogenic shock secondary to myocardial infarction.4 This can be attributed to the lack of demonstrated clinical benefit in randomized controlled trials and the advent of more advanced MCS devices.5, 6, 7 Nonetheless, IABP remains a useful modality given its percutaneous nature and wide availability. Retrospective studies have shown improved outcomes with the use of IABP in cases of biventricular failure.8 Early IABP studies showed beneficial effects in augmenting diastolic flow with simultaneous improvement in coronary flow to both ventricles and offloading LV myocardial workload.8,9 Yet, recent studies have shown conflicting results, suggesting worse outcomes in patients with right ventricular dysfunction undergoing IABP.10,11

Recent American and European acute heart failure guidelines emphasize pharmacological support with volume control and inotropic support, The routine use of IABP is not recommended for advanced heart failure patients (Class III indication). Nevertheless, its short-term use is suggested in selected individuals for bridge-to-recovery (BTR), bridge-to-decision (BTD), bridge-to-bridge (BTB), or bridge-to-transplant (BTT) cases (Class IIA indication).12,13

Despite these recommendations, there is a paucity of data from randomized controlled trials or registry data on outcomes with short-term MCS use in patients with RVD. We sought to analyze the characteristics and outcomes of patients undergoing IABP placement with RVD versus those without RVD using a nationally available large database (The National Inpatient Sample).