Durable Biventricular Support Using Right Atrial Placement of the HeartWare HVAD

Area of Science:

• Cardiology
• Mechanical Circulatory Support
• Cardiac Surgery

Background:

• Patients with Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) levels 1-2 and right ventricular failure face high mortality after continuous flow left ventricular assist device (CF-LVAD) implantation.
• Current biventricular support options, such as the Total Artificial Heart (TAH) or biventricular assist device (BiVAD) with bulky pumps, are limited.
• There is a critical need for effective biventricular support strategies in advanced heart failure.

Purpose of the Study:

• To describe a novel approach for biventricular support using HeartWare Ventricular Assist Devices (HVAD) in a left ventricular (LV-HVAD) and right atrial (RA-HVAD) configuration.
• To evaluate the outcomes of this innovative biventricular support strategy in consecutive INTERMACS levels 1-2 patients.
• To compare the efficacy and safety of this novel therapy against existing biventricular support methods.

Main Methods:

• A series of 11 consecutive INTERMACS levels 1-2 patients with evidence of biventricular failure underwent implantation of a CF-LVAD (10 LV-HVAD, 1 HeartMate II) and RA-HVAD.
• Patients accumulated a total of 4,314 biventricular assist device (BiVAD) support days.
• Outcomes including heart transplantation, ambulatory status, and adverse events were retrospectively analyzed.

Main Results:

• Seven patients successfully underwent orthotopic heart transplantation.
• Three patients remained ambulatory, awaiting transplantation or reconsideration.
• One mortality occurred due to intracranial bleeding; two patients experienced hemorrhagic strokes without sequelae; no ischemic strokes were reported. Two gastrointestinal bleeding events occurred.

Conclusions:

• This novel therapy utilizing LV-HVAD and RA-HVAD configurations is a viable alternative for biventricular support.
• The approach demonstrated superior outcomes compared to previously described methods for biventricular support in high-risk patients.
• This represents the largest series to date employing this specific biventricular support strategy.