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This review examines the role of percutaneous right ventricular assist devices (pRVADs) as a cornerstone of therapy in cases refractory to conventional management. Devices such as the Impella RP and dual-lumen cannulas provide targeted haemodynamic support, with indications in various clinical scenarios, including acute myocardial infarction, post-cardiac surgery, myocarditis, and after left ventricular assist device (LVAD) implantation. Successful implementation requires meticulous haemodynamic assessment, including parameters derived from pulmonary artery catheterization and echocardiography, to guide patient selection, optimize device placement, and monitor therapeutic response. The manuscript highlights contemporary weaning strategies, emphasizing recovery of right ventricular function, stabilization of systemic haemodynamics, and restoration of end-organ perfusion. While no universal protocols exist, this review presents a pragmatic framework informed by available evidence and expert consensus. Furthermore, the potential complications of pRVAD use\u2014ranging from thromboembolism and haemolysis to device-specific issues such as migration and tricuspid valve damage\u2014are discussed alongside preventive and management strategies. Key challenges in RHF management, including the interplay between right and left ventricular function, the impact of pulmonary vascular resistance, and the use of adjunctive pulmonary vasodilators, are addressed. The review underscores the absence of durable right ventricular assist devices and the need for innovation to close this therapeutic gap. Multidisciplinary collaboration among intensivists, cardiologists, and cardiac surgeons is critical to optimizing outcomes. This review provides actionable insights to assist clinicians in navigating the complexities of acute RHF, fostering a tailored and evidence-based approach to this high-risk population.<\/jats:p>","DOI":"10.1002\/ehf2.15305","type":"journal-article","created":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T00:10:19Z","timestamp":1745194219000},"page":"2652-2668","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Percutaneous Mechanical Circulatory Support for Acute Right Heart Failure: A Practical Approach"],"prefix":"10.1093","volume":"12","author":[{"given":"Mario","family":"Gramegna","sequence":"first","affiliation":[{"name":"Cardiac and Cardiac Surgery Intensive Care Unit, IRCCS San Raffaele Scientific Institute , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Vandenbriele","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven , Leuven ,","place":["Belgium"]},{"name":"Department of Adult Intensive Care, Royal Brompton & Harefield Hospitals, part of Guys' and St Thomas' Hospital NHS Foundation Trust , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Tavazzi","sequence":"additional","affiliation":[{"name":"Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, University of Pavia , Pavia ,","place":["Italy"]},{"name":"Intensive Care Unit, Fondazione Policlinico San Matteo IRCCS , Pavia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mir B.","family":"Basir","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Henry Ford Hospital , Detroit, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Bleakley","sequence":"additional","affiliation":[{"name":"Department of Adult Intensive Care, Royal Brompton & Harefield Hospitals, part of Guys' and St Thomas' Hospital NHS Foundation Trust , London ,","place":["UK"]},{"name":"Royal Free Hospital , London ,","place":["UK"]},{"name":"School of Medicine, University College Dublin , Dublin ,","place":["Ireland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Iannaccone","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, San Giovanni Bosco Hospital , ASL Citt\u00e0 di Torino, Turin ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Kretzschmar","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Innere Medizin I, Universitaetsklinikum Jena , Am Klinikum 1, Jena ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Maisano","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Mara","family":"Scandroglio","sequence":"additional","affiliation":[{"name":"Cardiac and Cardiac Surgery Intensive Care Unit, IRCCS San Raffaele Scientific Institute , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedikt","family":"Schrage","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Heart and Vascular Center , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. Christian","family":"Schultze","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Cardiology, Sophien-und Hufeland-Klinikum , Henry-van-de-Velde-Stra\u00dfe 2, Weimar ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Serrao","sequence":"additional","affiliation":[{"name":"The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai , New York, New York ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Tomey","sequence":"additional","affiliation":[{"name":"The Zena and Michael A. 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