Biventricular Circulatory Support With Two Miniaturized Implantable Assist Devices

Author:

Krabatsch Thomas1,Potapov Evgenij1,Stepanenko Alexander1,Schweiger Martin1,Kukucka Marian1,Huebler Michael1,Hennig Ewald1,Hetzer Roland1

Affiliation:

1. From the Deutsches Herzzentrum Berlin, Berlin, Germany.

Abstract

Background— Up to 30% of patients with end-stage heart failure experience biventricular failure that requires biventricular mechanical support. For these patients, only bulky extracorporeal or implantable displacement pumps or the total artificial heart have been available to date, which enables only limited quality of life for the patients. It was our goal to evaluate a method that would allow the use of 2 implantable centrifugal left ventricular assist devices as a biventricular assist system. Methods and Results— Seventeen patients have been implanted with 2 HeartWare HVAD pumps, 1 as a left ventricular assist device and 1 as a right ventricular assist device. Seventy-seven percent of the patients had idiopathic dilated or ischemic cardiomyopathy. Their age ranged from 29 to 73 years (mean 51.8±14.5 years), and 11 (64.7%) received intravenous catecholamine support preoperatively. The right ventricular assist device pump was implanted into the right ventricular free wall. The afterload of this pump was artificially increased by local reduction of the outflow graft diameter, and the effective length of its inflow cannula was reduced by the addition of two 5-mm silicon suture rings to the original HVAD implantation ring. All right ventricular assist device devices could be operated in appropriate speed ranges and delivered a flow of between 3.0 and 5.5 L/min. Thirty-day survival was 82%, and 59% of the patients could be discharged home after recovering from the operation. There was no clinically relevant hemolysis in any of the patients. Conclusions— Two HeartWare HVAD pumps can be used as a biventricular assist system. This implantable biventricular support gives the patients more comfort and mobility than usual biventricular ventricular assist devices with large and noisy displacement pumps.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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1. Effect of RVAD Cannulation Length on Right Ventricular Thrombosis Risk: An In Silico Investigation;Annals of Biomedical Engineering;2024-02-28

2. Current Limitations and Characteristics of Next‐Generation Ventricular Assist Devices;Textbook of Transplantation and Mechanical Support for End‐Stage Heart and Lung Disease;2023-09-08

3. Durable BiVADSupport: Configurations, Techniques, and Outcomes;Textbook of Transplantation and Mechanical Support for End‐Stage Heart and Lung Disease;2023-09-08

4. Biventricular mechanical circulatory support. History and current state of the problem;Russian Journal of Transplantology and Artificial Organs;2023-07-15

5. Experience with percutaneous right ventricular support in the early post-left ventricular assist device implantation period (clinical case report and literature reviews);Russian Journal of Transplantology and Artificial Organs;2023-04-08

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