TY - JOUR
T1 - Multicenter experience with durable biventricular assist devices
AU - Shah, Palak
AU - Ha, Richard
AU - Singh, Ramesh
AU - Cotts, William
AU - Adler, Eric
AU - Kiernan, Michael
AU - Brambatti, Michela
AU - Meehan, Karen
AU - Phillips, Sheila
AU - Kidambi, Sumanth
AU - Macaluso, Gregory P.
AU - Banerjee, Dipanjan
AU - Mooney, Dierdre
AU - Pham, Duc
AU - Pretorius, Victor D.
N1 - Funding Information:
Palak Shah reports grant support from Merck and Haemonetics. Ramesh Singh reports speaking for Baxter. Eric Adler reports grant support from and consulting for Abbott and Medtronic. Michael Kiernan reports consulting for Medtronic and a travel grant from Abbott. Karen Meehan reports speaking for Abbott. Gregory P. Macaluso reports consulting for Medtronic and Abbott and speaking for Novartis. Dipanjan Banerjee reports grant support from Medtronic and Abbott. Duc Pham reports consulting and speaking for Medtronic, Abbott, Abiomed, and TandemLife. Victor D. Pretorius reports speaking for Medtronic. None of the other authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.
Funding Information:
Palak Shah is supported by an American Heart Association Scientist Development Award co-funded by the Enduring Hearts Foundation. Michela Brambatti is supported by a personal award from the College of Physician and Surgeons of Ancona, Italy.
Publisher Copyright:
© 2018 International Society for Heart and Lung Transplantation
PY - 2018/9
Y1 - 2018/9
N2 - BACKGROUND: Severe right ventricular failure necessitating a right ventricular assist device (RVAD) complicates 6% to 11% of left ventricular assist device (LVAD) implants. Patient outcomes for those receiving durable continuous-flow VADs in a biventricular configuration (i.e., BiVAD) have been reported in limited case series. METHODS: Data from United States centers with ≥ 6 BiVAD implants were collected. Characteristics and outcomes of patients receiving contemporaneous (i.e., same surgery) vs staged implantation of the HVAD as a BiVAD were compared. RESULTS: From 2011 to 2017, 46 patients received durable BiVADs and had the following characteristics: median age, 46 years (interquartile range [IQR], 19–67 years), non-ischemic cardiomyopathy (80%), bridge to transplant (83%), Interagency Registry for Mechanically Assisted Circulatory Support Profile 1 or 2 (92%), use of temporary circulatory support (37%), right atrial pressure 19 mm Hg (IQR, 14–23 mm Hg), and cardiac index of 1.6 liters/min/m2 (IQR, 1.2–2.1 liters/min/m2). Operative mortality was 33%. Equal numbers of patients received a right atrial or right ventricular implant. Contemporaneous BiVAD implantation occurred in 31 patients (67%), and compared with 15 patients (33%) with staged implants, these patients had a shorter intensive care unit length of stay of 12 days (IQR, 7–23 days) vs 42 days (IQR, 28–48 days, p = 0.035) and were more likely to be discharged from the hospital on BiVAD support (61% vs 27%, p = 0.04). RVAD thrombosis developed in 17 patients (37%). Patients with contemporaneous BiVAD implants had a 1-year survival of 74% compared with 40% in staged BiVAD patients (p = 0.11). CONCLUSIONS: Patients receiving durable BiVADs represent a critically ill patient population with severe biventricular failure who have high operative mortality and RVAD thrombosis rates. The 1-year survival for patients receiving contemporaneous BiVADs in experienced centers mirrors other contemporary durable biventricular support strategies.
AB - BACKGROUND: Severe right ventricular failure necessitating a right ventricular assist device (RVAD) complicates 6% to 11% of left ventricular assist device (LVAD) implants. Patient outcomes for those receiving durable continuous-flow VADs in a biventricular configuration (i.e., BiVAD) have been reported in limited case series. METHODS: Data from United States centers with ≥ 6 BiVAD implants were collected. Characteristics and outcomes of patients receiving contemporaneous (i.e., same surgery) vs staged implantation of the HVAD as a BiVAD were compared. RESULTS: From 2011 to 2017, 46 patients received durable BiVADs and had the following characteristics: median age, 46 years (interquartile range [IQR], 19–67 years), non-ischemic cardiomyopathy (80%), bridge to transplant (83%), Interagency Registry for Mechanically Assisted Circulatory Support Profile 1 or 2 (92%), use of temporary circulatory support (37%), right atrial pressure 19 mm Hg (IQR, 14–23 mm Hg), and cardiac index of 1.6 liters/min/m2 (IQR, 1.2–2.1 liters/min/m2). Operative mortality was 33%. Equal numbers of patients received a right atrial or right ventricular implant. Contemporaneous BiVAD implantation occurred in 31 patients (67%), and compared with 15 patients (33%) with staged implants, these patients had a shorter intensive care unit length of stay of 12 days (IQR, 7–23 days) vs 42 days (IQR, 28–48 days, p = 0.035) and were more likely to be discharged from the hospital on BiVAD support (61% vs 27%, p = 0.04). RVAD thrombosis developed in 17 patients (37%). Patients with contemporaneous BiVAD implants had a 1-year survival of 74% compared with 40% in staged BiVAD patients (p = 0.11). CONCLUSIONS: Patients receiving durable BiVADs represent a critically ill patient population with severe biventricular failure who have high operative mortality and RVAD thrombosis rates. The 1-year survival for patients receiving contemporaneous BiVADs in experienced centers mirrors other contemporary durable biventricular support strategies.
KW - biventricular assist device
KW - cardiogenic shock
KW - heart failure
KW - right heart failure
KW - ventricular assist device
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U2 - 10.1016/j.healun.2018.05.001
DO - 10.1016/j.healun.2018.05.001
M3 - Article
C2 - 30173824
AN - SCOPUS:85052493084
VL - 37
SP - 1093
EP - 1101
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
SN - 1053-2498
IS - 9
ER -