Multicenter experience with durable biventricular assist devices

Palak Shah; Richard Ha; Ramesh Singh; William Cotts; Eric Adler; Michael Kiernan; Michela Brambatti; Karen Meehan; Sheila Phillips; Sumanth Kidambi; Gregory P. Macaluso; Dipanjan Banerjee; Dierdre Mooney; Duc Pham; Victor D. Pretorius

doi:10.1016/j.healun.2018.05.001

Multicenter experience with durable biventricular assist devices

Palak Shah^*, Richard Ha, Ramesh Singh, William Cotts, Eric Adler, Michael Kiernan, Michela Brambatti, Karen Meehan, Sheila Phillips, Sumanth Kidambi, Gregory P. Macaluso, Dipanjan Banerjee, Dierdre Mooney, Duc Pham, Victor D. Pretorius

^*Corresponding author for this work

Surgery, Cardiac Surgery Division

Research output: Contribution to journal › Article › peer-review

56 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	1093-1101
Number of pages	9
Journal	Journal of Heart and Lung Transplantation
Volume	37
Issue number	9
DOIs	https://doi.org/10.1016/j.healun.2018.05.001
State	Published - Sep 2018

Funding

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. This work was supported by an unrestricted research grant from Medtronic Inc. The sponsor played no part in data collection, analysis, or in drafting and editing of the manuscript.

Keywords

biventricular assist device
cardiogenic shock
heart failure
right heart failure
ventricular assist device

ASJC Scopus subject areas

Surgery
Pulmonary and Respiratory Medicine
Cardiology and Cardiovascular Medicine
Transplantation

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10.1016/j.healun.2018.05.001

Cite this

@article{0a8a0cc27b494a969b425e2733601012,

title = "Multicenter experience with durable biventricular assist devices",

abstract = "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.",

keywords = "biventricular assist device, cardiogenic shock, heart failure, right heart failure, ventricular assist device",

author = "Palak Shah and Richard Ha and Ramesh Singh and William Cotts and Eric Adler and Michael Kiernan and Michela Brambatti and Karen Meehan and Sheila Phillips and Sumanth Kidambi and Macaluso, {Gregory P.} and Dipanjan Banerjee and Dierdre Mooney and Duc Pham and Pretorius, {Victor D.}",

note = "Publisher Copyright: {\textcopyright} 2018 International Society for Heart and Lung Transplantation",

year = "2018",

month = sep,

doi = "10.1016/j.healun.2018.05.001",

language = "English (US)",

volume = "37",

pages = "1093--1101",

journal = "Journal of Heart and Lung Transplantation",

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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.

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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Multicenter experience with durable biventricular assist devices

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