Biventricular Support With Intracorporeal, Continuous Flow, Centrifugal Ventricular Assist Devices

Arabía, Francisco A.; Milano, Carmelo A.; Mahr, Claudius; McGee, Edwin C.; Mokadam, Nahush A.; Rame, J. Eduardo; Moriguchi, J.; Ramzy, Danny; Naftel, David C.; Myers, Susan; Kirklin, James K.

doi:10.1016/j.athoracsur.2017.08.019

Cited by 31 publications

(25 citation statements)

References 28 publications

(25 reference statements)

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“…2 CF-LVADs) support might be considered in patients at high risk of RV failure having bridge to transplant [81, 187–191]. Off-label use of implantable axial-flow or centrifugal LVADs has been adopted as RVAD support in conjunction with implantable LVAD support as an alternative to extracorporeal BiVAD or TAH implantation [192–196]. …”

Section: System Selectionmentioning

confidence: 99%

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2019 EACTS Expert Consensus on long-term mechanical circulatory support

Potapov

Antonides

Crespo-Leiro

et al. 2019

European Journal of Cardio-Thoracic Surgery

279

446

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Long-term mechanical circulatory support (LT-MCS) is an important treatment modality for patients with severe heart failure. Different devices are available, and many—sometimes contradictory—observations regarding patient selection, surgical techniques, perioperative management and follow-up have been published. With the growing expertise in this field, the European Association for Cardio-Thoracic Surgery (EACTS) recognized a need for a structured multidisciplinary consensus about the approach to patients with LT-MCS. However, the evidence published so far is insufficient to allow for generation of meaningful guidelines complying with EACTS requirements. Instead, the EACTS presents an expert opinion in the LT-MCS field. This expert opinion addresses patient evaluation and preoperative optimization as well as management of cardiac and non-cardiac comorbidities. Further, extensive operative implantation techniques are summarized and evaluated by leading experts, depending on both patient characteristics and device selection. The faculty recognized that postoperative management is multidisciplinary and includes aspects of intensive care unit stay, rehabilitation, ambulatory care, myocardial recovery and end-of-life care and mirrored this fact in this paper. Additionally, the opinions of experts on diagnosis and management of adverse events including bleeding, cerebrovascular accidents and device malfunction are presented. In this expert consensus, the evidence for the complete management from patient selection to end-of-life care is carefully reviewed with the aim of guiding clinicians in optimizing management of patients considered for or supported by an LT-MCS device.

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Section: System Selectionmentioning

confidence: 99%

“…Off-label use of implantable axial-flow or centrifugal LVADs has been adopted as RVAD support in conjunction with implantable LVAD support as an alternative to extracorporeal BiVAD or TAH implantation [192–196].…”

Section: System Selectionmentioning

confidence: 99%

2019 EACTS Expert Consensus on long-term mechanical circulatory support

Potapov

Antonides

Crespo-Leiro

et al. 2019

European Journal of Cardio-Thoracic Surgery

279

446

View full text Add to dashboard Cite

show abstract

“…A permanent and on-label long-term mechanical solution for right ventricular devices does not exist outside of use of the Total Artificial Heart (TAH) and the BerlinHeart Excor-a pulsatile device that may be used as biventricular support in Europe. However, the TAH does not fall into the classification of biventricular assist device (BiVAD) as it replaces the failing ventricles as opposed to assisting them (15). Hence, without an on-label solution, clinicians have resorted to using left-sided continuous-flow ventricular assist devices (VADs) in the right sided position for patients with severe biventricular failure (16).…”

Section: Introductionmentioning

confidence: 99%

Contemporary outcomes of continuous-flow biventricular assist devices

Farag¹,

Woldendorp²,

McNamara³

et al. 2021

Ann Cardiothorac Surg

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Background: Significant right ventricular failure (RVF) complicating left ventricular assist device (LVAD) placement has been reported at 10-30%. Although primarily indicated for left ventricular failure, ventricular assist devices (VADs) have become utilized in a biventricular setup to combat right ventricular failure (RVF) following LVAD implantation. With the advent of continuous-flow LVADs (CF-LVADs) superseding their pulsatile predecessors, the shift towards CF-biventricular assist devices (CF-BiVADs) come with the prospect of improved outcomes over previous pulsatile BiVADs. We aim to review the literature and determine the outcomes of CF-BiVAD recipients.Methods: A systematic review was performed to determine the outcomes of CF-BiVADs. Pre-operative demographics and device configuration data was collected. Primary outcomes evaluated were short-term survival, long-term survival, duration of support, and survival to transplant. Secondary outcomes evaluated included intensive care unit (ICU) and hospital length of stay (ICU-LOS and HLOS, respectively), pump thrombosis, pump exchange. Median and interquartile range was reported where appropriate. A major limitation was the likely overlap of cohorts across publications, which may have contributed to some selection bias.Results: Of 1,282 screened, 12 publications were evaluated. Sample size ranged from 4 to 93 CF-BiVAD recipients, and follow-up ranged from 6 to 24 months. Mean age ranged from 34 to 52 years old. Forty-five percent of CF-BiVADs had right atrial (RA-) inflow cannulation, with the remaining being right ventricular (RV). Thirty-day survival was a median of 90% (IQR 82-97.8%) and 12-month survival was a median of 58.5% (IQR 47.5-62%). Where reported, rate of pump thrombosis (predominantly the right VAD) was a median of 31% (IQR 14-36%), although pump exchange was only 9% (IQR 1.5-12.5%).Conclusions: RVF post-LVAD implantation is a high morbidity and mortality complication. There is no on-label continuous-flow RVAD currently available. Thus, the modifications of LVADs for right ventricular support to combat pump thrombosis has resulted in various techniques. BiVAD recipients are predominantly transplant candidates, and complications of pump thrombosis and driveline infection whilst on wait-list are of great consequence. This study demonstrates the need for an on-label CF-BiVAD.

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“…17 Comparison of results from LVADs and biventricular assist devices (BiVADs) have suggested that the patient's condition at implantation rather than device technology may dominate the calculus of inferior survival with biventricular support. 18,19 However, TAHs and BiVADs have different profiles of survival and are associated with different adverse events (AEs). Others showed that survival rates were higher in patients who had a TAH implanted compared with patients who received support from implantable or paracorporeal BiVADs for longer than 90 days.…”

mentioning

confidence: 99%