Tharakan-VAD (T-VAD): Advancing Right Ventricular Support in Patients Undergoing LVAD Implantation
A Surgical Innovation in Advanced Heart Failure Management
Right ventricular failure remains one of the most challenging complications following implantation of a durable left ventricular assist device (LVAD). In patients with advanced heart failure, inadequate right ventricular function can compromise LVAD performance, prolong hospitalization, and significantly affect recovery.
To address this challenge, Dr. Ajit K. Tharakan and his team at Oklahoma Heart Institute developed and implemented a modified surgical approach to temporary right ventricular mechanical support, known as the Tharakan-Ventricular Assist Device (T-VAD), in Tulsa, Oklahoma.
The Tharakan-VAD Technique
The T-VAD is a surgically configured temporary right ventricular assist system designed to bypass the failing right ventricle while maintaining blood flow through the pulmonary circulation and adequate filling of the implanted LVAD.
The technique involves connecting an 8-mm vascular graft to the main pulmonary artery and tunneling it to the right side of the neck, where it is connected to a 19-Fr return cannula. Venous blood is drained through a femoral venous cannula and circulated using a CentriMag mechanical support pump.
A distinguishing feature of this configuration is the placement of the pulmonary artery graft exit above the right clavicle, rather than through the abdominal or lower chest wall. This allows primary sternal closure, facilitates patient positioning and mobilization, and permits subsequent device removal without reopening the sternum.
The circuit can also incorporate an oxygenator when additional respiratory support is required.
Published Clinical Experience
In a study published in JHLT Open in 2026, Dr. Tharakan and colleagues reported their institutional experience involving 79 patients undergoing durable LVAD implantation between 2018 and 2026.
Right ventricular failure requiring temporary mechanical support occurred in 25 patients (32%). Of these, 19 received T-VAD support.
Among patients treated with T-VAD:
- 95% (18 of 19) survived to hospital discharge.
- Median duration of temporary support was 11 days.
- Reoperation for bleeding occurred in 11%.
- Renal replacement therapy was required in 11%.
- None of the patients discharged alive required ongoing continuous inotropic support.
These findings demonstrate the feasibility of the technique and encouraging clinical outcomes in a challenging patient population. As a single-center observational study, the results do not establish superiority over other right ventricular support strategies.
Looking Ahead
The development of T-VAD reflects Dr. Tharakan's ongoing commitment to advancing surgical treatment for patients with complex heart failure and cardiogenic shock.
Future research will focus on identifying patients who may benefit from earlier right ventricular support, optimizing the timing of implantation, and developing objective criteria for right ventricular recovery and device removal.
The ultimate goal is to make temporary right ventricular support more predictable, reproducible, and effective while improving recovery after durable LVAD implantation.
Published Research
Tharakan M, Quiroz LM, Stroud S, et al. Surgical venous-to–pulmonary artery temporary right ventricular support after durable left ventricular assist device implantation: A single-center experience. JHLT Open. 2026;14:100682.