Outcomes of contemporary mechanical circulatory support device configurations in patients with severe biventricular failure

Allison P. Levin, Natalia Jaramillo, A. Reshad Garan, Koji Takeda, Hiroo Takayama, Melana Yuzefpolskaya, Donna M. Mancini, Yoshifumi Naka, Paolo C. Colombo, Veli K. Topkara

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

Objectives Severe right ventricular failure often is considered a contraindication for left ventricular assist device (LVAD) therapy and necessitates use of biventricular assist devices (BiVADs). Available options for BiVADs are limited, and comparative outcomes are largely unknown. Methods Heart transplant candidates who were registered on the United Network for Organ Sharing waitlist and underwent long-term contemporary LVAD (n = 3195) or BiVAD (n = 408) implantation, from January 2010 through June 2014, were retrospectively analyzed. We evaluated clinical characteristics and outcomes of patients requiring a BiVAD, as well as regional differences in utilization of this technology. Results Patients requiring a BiVAD were younger (48.9 vs 53.3 years), had a higher proportion of nonischemic disease (69.1% vs 58.2%), a higher bilirubin level (0.9 vs 0.7 mg/dL), and a lower 6-month survival rate (68.1% vs 92.7%) after device implantation (all P <.05). Postimplantation and posttransplantation survival was comparable for commonly used BiVAD configurations, including total artificial heart, continuous flow BiVAD, a continuous-flow LVAD coupled with a right-sided device, and pulsatile flow. Significant variation was found in regional utilization of these devices, regardless of differences in transplantation waitlist times. A large body surface area was an independent predictor of mortality on a BiVAD (hazard ratio = 2.12, P =.017). Conclusions Outcomes of patients requiring a BiVAD remain poor in the contemporary device era, regardless of the configuration used. Among other clinical factors, body surface area should be incorporated into decision making for device selection in these patients.

Original languageEnglish
Pages (from-to)530-535.e2
JournalJournal of Thoracic and Cardiovascular Surgery
Volume151
Issue number2
DOIs
StatePublished - 1 Feb 2016
Externally publishedYes

Keywords

  • biventricular support
  • right ventricular failure
  • ventricular assist device

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