Long-Term Implantable Biventricular Assist Device Support　- Experience of 6 Cases

Managing heart failure complicated by severe right heart failure with implantable mechanical circulatory support remains a significant challenge. One therapeutic strategy is biventricular assist device (BiVAD) support, typically involving the off-label use of 2 implantable left ventricular assist devices (LVADs). Because the available data of implantable BiVAD support remain limited, we reviewed the data for 6 patients on implantable BiVAD support.

Between January 2010 and March 2019, 6 patients underwent BiVAD implantation at Osaka University Hospital. Their mean age was 31±11 years, and 2 (33%) were male. The right ventricular assist devices (RVADs) utilized were Jarvik2000 (Jarvik Heart, NY, USA) in 4 patients (67%), and HVAD (HeartWare, Framingham, MA, USA) in 2 patients (33%). The survival rates at 1 and 3 years after BiVAD implantation were 83% and 67%, respectively. Of the 6 patients, 4 underwent heart transplantation at 553, 709, 791, and 1,245 days, respectively, following RVAD implantation; 2 patients died during follow-up at 280 and 511 days, respectively, after RVAD implantation. Stroke occurred in 3 patients. Hemolysis or pump thrombosis occurred in 3 patients. Heart failure occurred in 3 patients. Device-related infection occurred in 1 patient.

Although implantable BiVAD support provided a feasible bridge to transplantation with favorable survival, the high incidence of complications indicates that significant challenges remain in optimizing patient outcomes and emphasizes the necessity for RV-specific device development.