*3.1.1 Early right heart failure*

Timely identification of RV failure in the immediate postoperative period may be challenging but is of critical importance. As noted, early post-operative diuretic and inotrope use are routine. However, rising lactic acid levels, evidence of end organ dysfunction, and/or persistent or increasing vasoactive medication doses signal that RV mechanical support may be required. Importantly, the timing of RVAD initiation affects prognosis. In a multicenter retrospective analysis of 91 patients requiring RV support, an RVAD was implanted at the time of the LVAD in 44% with 56% receiving
