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Durable Biventricular Support Using Right Atrial Placement of the HeartWare HVAD

Tran, Hao A.; Pollema, Travis L.; Silva Enciso, Jorge; Greenberg, Barry H.; Barnard, Denise D.; Adler, Eric D.; Pretorius, Victor G.
doi: 10.1097/MAT.0000000000000645
Adult Circulatory Support: PDF Only

Patients with Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) levels 1–2 who either have or are at risk for right ventricular failure face significant morbidity and mortality after continuous flow left ventricular assist device (CF-LVAD) implantation. Currently, the options for biventricular support are limited the Total Artificial Heart (TAH; CardioWest, Syncardia, Tuscon, AZ) or biventricular assist device (BiVAD), which uses bulky extracorporeal or implantable displacement pumps. We describe a successful series based on an innovative approach for biventricular support in consecutive INTERMACS levels 1–2 patients utilizing a HeartWare Ventricular Assist Device (HVAD; HeartWare, Framingham, MA) in a left ventricular (LV-HVAD) and a right atrial (RA-HVAD) configuration. From June 2014 through May 2016, 11 consecutive INTERMACS levels 1–2 patients with evidence of biventricular failure underwent implantation of a CF LVAD (10 LV-HVAD and 1 HeartMate II LVAD, Thoratec, Pleasanton, CA) and RA-HVAD pumps. A total of 4,314 BiVAD support days were accumulated in our case series. Seven patients have undergone orthotopic heart transplant, whereas 3 are ambulatory and are either waiting transplant or reconsideration for transplantation. There is one mortality in this case series, which was due to an intracranial bleed from supratherapeutic anticoagulation. Two other patients experienced hemorrhagic strokes, but without neurologic sequelae, whereas no patients have experienced ischemic strokes. There were two episodes of gastrointestinal bleeding. This is the largest series to date involving this approach with outcomes superior to those previously described in patients receiving biventricular support. We conclude this novel therapy is a viable alternative to current practices in the management of biventricular failure.

Submitted for consideration January 2017; accepted for publication in revised form July 2017.

Disclosure: The authors have no conflicts of interest to report.

Correspondence: Victor G. Pretorius, Division of Cardiothoracic Surgery, Department of Surgery, Sulpizio Cardiovascular Center, University of California, San Diego, 9434 Medical Center Drive, La Jolla, CA 92037. Email: gpretrious@ucsd.edu.

Copyright © 2017 by the American Society for Artificial Internal Organs