Non-Traditional Inflow, Outflow, and Biventricular Configurations of Durable Ventricular Assist Devices

Ventricular assist device (VAD) technologies have advanced in recent years from large, pulsatile devices to smaller continuous flow (CF) pumps. As such, their design has allowed surgeons to pioneer less invasive methods of implantation with alternative configurations to treat a larger number of patients with varied types of cardiomyopathies who are often sick with high-risk clinical scenarios. In recent years, these patients appear to have a higher degree of vascular disease and have had multiple prior cardiac surgeries. In this review, we highlight both standard as well as alternative VAD configurations including additional inflow and outflow cannulation techniques along with considerations for biventricular support for both durable biventricular VADs and as a total artificial heart configuration.