An Institutional Comparison of Patients Supported With Surgical vs Percutaneous Biventricular Assist Devices

Surgical (sBiVADs) are well established in end-stage heart failure, whereas newer and less invasive percutaneous biventricular assist devices (pBiVADs) are understudied. These 2 approaches are reported in a large series of patients with pBiVADs.

All consecutive biventricular assist device (BiVAD)-supported patients at a single institution (Keck Hospital of USC, Los Angeles, CA) from 2014 to 2023 were retrospectively reviewed (n = 46). Patients with sBiVADs (n = 27) and pBiVADs (n = 19) (defined as Impella 5.5 with Impella RP [Abiomed; n = 4] or percutaneous oxygenated right ventricular assist devices [n = 15]) were compared.

There were no significant differences in preoperative risk factors. Patients with pBiVADs required fewer intraoperative packed red blood cell (2.0 vs 6.0; P < .001), fresh frozen plasma (0.0 vs 4.0; P = .001), and platelet (0.0 vs 4.0; P = .001) transfusions. Patients with pBiVADs had fewer unanticipated returns to the operating room (0.47 [SD 0.70] vs 2.22 [1.87] per patient; P < .001) and fewer postoperative packed red blood cell (8.0 vs 27.0; P < .001), fresh frozen plasma (1.0 vs 8.0; P < .001), and platelet (0.0 vs 10.0; P < .001) transfusions. Thirty-day survival was not significantly different between patients with sBiVADs and those with pBiVADs (56.6% vs 36.8%; P = .341).

The study investigators consider pBiVAD to be a less invasive, viable bridge to transplantation, durable left ventricular assist device therapy, or recovery.