Expert Consensus on Clinical Application of Implantable Biventricular Assist Devices

Area of Science:

• Cardiology
• Mechanical Circulatory Support
• Heart Failure Management

Background:

• Biventricular heart failure (BHF) management is challenging, with underutilization of biventricular assist devices (BiVADs) in Western countries.
• The application and expertise in BiVADs are growing significantly within China.
• A need exists for standardized protocols integrating international guidelines and local clinical experience.

Framework:

• This consensus synthesizes international guidelines, medical evidence, and Chinese clinical expertise.
• Key recommendations focus on preoperative assessment, indications, surgical approach, and anticoagulation.
• Utilizes a classification system for recommendations (Class I, IIa, III).

Implementation:

• Preoperative assessment includes right heart catheterization and echocardiography for CVP:PCWP ratio and PAPi (Class I).
• BiVADs are indicated for refractory BHF or high-risk right heart failure post-LVAD (Class IIa).
• Right atrial implantation is the preferred surgical approach (Class IIa).

Implications:

• Warfarin-based anticoagulation (INR 2.0-2.5) with aspirin is recommended; direct oral anticoagulants (DOACs) are advised against (Class III).
• Addresses critical gaps in patient selection, pump speed titration, and complication management.
• Integrated BiVAD systems offer a promising solution for complex BHF, improving patient outcomes.