title: Biventricular cannulation is superior regarding hemodynamics and organ recovery in patients on biventricular assist device support.
abstract: BACKGROUND
  Adequate pump flow is a prerequisite for recovery of end-organ failure and outcome in patients treated with a biventricular assist device (BiVAD). We hypothesized that hemodynamics and organ recovery would improve after biventricular, apical cannulation compared with right atrial cannulation.
  
  
  METHODS
  Between 2003 and 2009, we treated 31 patients (21 men, 10 women; mean age, of 43 ± 15 years) with a paracorporeal BiVAD (Thoratec BVAD, Pleasanton, CA). In 15 of 31 patients, the inflow cannula of the right VAD (RVAD) was positioned inside the right ventricle (RV) through the RV apex (biapical) instead of the right atrium (conventional). We analyzed pump flow, driving pressure, and vacuum of the Thoratec driving console and recovery of kidney (creatinine, blood urea nitrogen) and liver function (bilirubin).
  
  
  RESULTS
  Mean duration of BiVAD support was 84 ± 72 days. BiVAD weaning was successful in 4 of 31 patients (13%), 12 underwent cardiac transplantation (39%), and 15 (48%) died. We observed significantly higher pump flow of the LVAD and RVAD in patients after biapical cannulation compared with those with conventional cannulation (LVAD, 5.6 ± 0.4 vs 5.1 ± 0.3 liters/min, p = 0.002; and RVAD: 4.9 ± 0.3 vs 4.2 ± 0.3 liters/min, p < 0.001). This superior circulatory support correlated with faster recovery of kidney function.
  
  
  CONCLUSIONS
  Cardiac support with a BiVAD is hemodynamically more effective after biventricular apical cannulation compared with conventional right atrial cannulation. Consequently, higher pump flow results in better end-organ recovery using biapical cannulation.
authors.affiliation: Department of Cardiovascular Surgery, University Medical Center, Freiburg, Germany. christian.schlensak@uniklinik-freiburg.de
authors.forename: Christian
authors.initials: C
authors.lastname: Schlensak
authors.forename: David
authors.initials: D
authors.lastname: Schibilsky
authors.forename: Matthias
authors.initials: M
authors.lastname: Siepe
authors.forename: Kerstin
authors.initials: K
authors.lastname: Brehm
authors.forename: Rolf
authors.initials: R
authors.lastname: Klemm
authors.forename: Robert
authors.initials: R
authors.lastname: von Wattenwyl
authors.forename: Michael
authors.initials: M
authors.lastname: Berchthold-Herz
authors.forename: Christoph
authors.initials: C
authors.lastname: Benk
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Beyersdorf
mesh_terms: D000328:Adult; D058409:Cardiac Resynchronization Therapy Devices; D002404:Catheterization; D005260:Female; D006321:Heart / Q000502:physiology; D006325:Heart Atria / Q000503:physiopathology; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000502:physiology; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D016896:Treatment Outcome