Three Ventricular Assist Devices (True TriVAD) as Bridge to Durable Biventricular Support (BiVAD) in LVAD Patient With Severe Aortic Regurgitation

A Left Ventricular Assist Device (LVAD) patient developed severe aortic regurgitation (AR), leading to right heart failure and multi-organ dysfunction (MOD). Temporary Right Ventricular Assist Device (tRVAD) support caused left ventricle (LV) overload and pulmonary edema. Implantation of an Impella 5.5 successfully unloaded the LV and stabilized the patient, enabling durable RVAD implantation with surgical aortic valve replacement (SAVR). The case highlights the importance of early AR recognition and tailored mechanical circulatory support.