Abstract 19427: Biventricular Circulatory Support with Two Miniaturized Implantable Assist Devices
Introduction: The implantation of left ventricular assist devices (LVAD) in end-stage heart failure patients is routine. For patients who require bi-ventricular support, however, only systems with large extracorporeal pneumatic components - VADs or the total artificial heart - are available. These offer only limited quality of life to the patient. We report a novel technique using two implantable centrifugal pumps as a biventricular support system.
Patients and methods: Thirteen patients (10 male, 3 female) received two HeartWare HVAD centrifugal pumps (HeartWare Inc., Framingham, MA) - one as LVAD and one as RVAD with connection either to the free wall of the right ventricle or to the right atrium. As the low resistance of the pulmonary circulation would lead to an inappropriately high RVAD flow, we narrowed the outflow graft of the RVAD to half of its diameter, thereby increasing the afterload of the pump. Ten patients were suffering from idiopathic dilative cardiomyopathy, three from end-stage ischemic disease. All but two patients had biventricular decompensation despite inotropic support (Intermacs II). Considering clinical parameters and calculated scores for all the patients, left ventricular support alone was regarded as insufficient. Patients' ages ranged from 29 to 73 years and body mass index from 17 to 26 kg/m2.
Results: Perioperative (30-day) survival was 77% and so far 7 of the 10 survivors have been discharged home. No late deaths have occurred up to now. The first of the patients has now been supported for 250 days. No thromboembolic events and no driveline, pocket or wound infections have been detected. Clinical parameters of hemolysis have not been significantly increased compared to those of our LVAD patients with the same pump.
Conclusion: The implantation of two HeartWare pumps is a safe and effective option for patients requiring biventricular support. The crucial technical aspect allowing the use of the HVAD pump as RVAD is the narrowing of the outflow graft, in order to raise the resistance, thus optimizing the flow/pressure relationship.
- © 2010 by American Heart Association, Inc.