Surgical Considerations and Challenges for Bilateral Continuous-Flow Durable Device Implantation.

Area of Science:

• Cardiovascular Surgery
• Medical Devices
• Heart Failure Management

Background:

• Biventricular support with durable centrifugal pumps is an evolving field.
• Optimal surgical strategies for right-sided device implantation remain undefined.
• Medically refractory biventricular heart failure requires advanced support solutions.

Purpose of the Study:

• To present an optimal surgical strategy for bilateral HeartWare continuous-flow ventricular assist device (HVAD) implantation.
• To discuss surgical considerations and potential risks associated with biventricular HVAD implantation.
• To offer insights into managing patients with biventricular heart failure requiring mechanical support.

Main Methods:

• A series of four patients underwent simultaneous or sequential bilateral HVAD implantation.
• Surgical considerations including right ventricular positioning and outflow anastomosis were addressed.
• Device speed adjustments and management of potential complications were evaluated.

Main Results:

• One patient died while on support; three patients experienced pump thrombosis requiring revision.
• Three patients survived to orthotopic heart transplantation, with one succumbing to perioperative complications.
• The study highlights a high incidence of pump thrombosis in this patient cohort.

Conclusions:

• Surgical management of biventricular heart failure with HVADs is challenging.
• Pump thrombosis is a significant complication requiring further investigation and management strategies.
• There is a critical need for expert consensus and best practice guidelines for this patient population.