Prolonged biventricular assist device support as a bridge to heart transplantation

We report a case in which long-term biventricular assist device (BiVAD) support enabled successful heart transplantation. The patient was diagnosed with dilated cardiomyopathy at age 11. She underwent implantation of a Toyobo LVAD, tricuspid valvuloplasty and annuloplasty at age 15. Right heart bypass (RHB) was established using a centrifugal pump. Right ventricular function showed no improvement during a ten-day period, and RHB was switched to a Toyobo RVAD on postoperative day (POD) 11. Because of poor oxygenation, veno-venous extracorporeal membrane oxygenation (V-V ECMO) was instituted. She was weaned from V-V ECMO on POD 14. She was brought to the United States on POD 189 under BiVAD support, and underwent heart transplantation on POD 199. She was discharged 4 months later. Two years after heart transplantation, she remained in New York Heart Association class one without rejection.