Biventricular mechanical support devices – clinical perspectives

ABSTRACT

Cardiac transplantation remains the optimal treatment for end stage heart failure in selected patients. However, the shortage of donor hearts, rigorous eligibility criteria and long waiting lists have increased the demand for alternative treatment strategies such as mechanical circulatory support. While many patients are adequately supported with left ventricular assist devices, frequently there is right heart failure or involvement of the right ventricle, requiring biventricular support. Pulsatile flow biventricular devices and total artificial hearts approved for temporary biventricular support have limitations including size, high rates of adverse events and restricted mobility which makes them unsuitable for long term support. A number of centres have reported dual continuous flow left ventricular assist devices as a means of supporting the left and right heart. This review will summarise the literature on the outcomes and complications from current biventricular support devices and assess the role of dual continuous flow VAD therapy, and the new continuous flow total heart replacement devices.

KEYWORDS:

• Biventricular assist device
• BiVAD
• mechanical circulatory support
• ventricular assist device
• chronic heart failure
• continuous flow pumps

Acknowledgements

Sajad Shehab and Sabine M Allida are supported by the Australian Post-graduate Award from the Australian Government. Dr Phillip J Newton is a Post-Doctoral Research Fellow supported by a Chancellor’s Post-Doctoral Fellowship from the University of Technology, Sydney.

Financial and competing interests disclosure

P.C. Jansz has received consultation fee from HeartWare Inc. C.S. Hayward has received consultation fees from HeartWare Inc. unrelated to the current study and received a Travel Fund from Thoratec Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.