Acute-on-chronic right ventricular failure has a tremendously high
mortality rate and pulmonary artery hypertension plays a major role in
the progression of secondary right ventricular failure. Here, we report
a case of drug-refractory acute-on-chronic right ventricular failure due
to primary artery hypertension and a two-step approach of a percutaneous
dual-outflow extracorporeal membrane oxygenation support set-up
implanted under on-going mechanical resuscitation for immediate
biventricular support with a consequent downgrade to right ventricular
assist device after left ventricular recompensation.