title: Biventricular circulatory support with two miniaturized implantable assist devices.
abstract: BACKGROUND
  Up to 30% of patients with end-stage heart failure experience biventricular failure that requires biventricular mechanical support. For these patients, only bulky extracorporeal or implantable displacement pumps or the total artificial heart have been available to date, which enables only limited quality of life for the patients. It was our goal to evaluate a method that would allow the use of 2 implantable centrifugal left ventricular assist devices as a biventricular assist system.
  
  
  RESULTS
  Seventeen patients have been implanted with 2 HeartWare HVAD pumps, 1 as a left ventricular assist device and 1 as a right ventricular assist device. Seventy-seven percent of the patients had idiopathic dilated or ischemic cardiomyopathy. Their age ranged from 29 to 73 years (mean 51.8 ± 14.5 years), and 11 (64.7%) received intravenous catecholamine support preoperatively. The right ventricular assist device pump was implanted into the right ventricular free wall. The afterload of this pump was artificially increased by local reduction of the outflow graft diameter, and the effective length of its inflow cannula was reduced by the addition of two 5-mm silicon suture rings to the original HVAD implantation ring. All right ventricular assist device devices could be operated in appropriate speed ranges and delivered a flow of between 3.0 and 5.5 L/min. Thirty-day survival was 82%, and 59% of the patients could be discharged home after recovering from the operation. There was no clinically relevant hemolysis in any of the patients.
  
  
  CONCLUSIONS
  Two HeartWare HVAD pumps can be used as a biventricular assist system. This implantable biventricular support gives the patients more comfort and mobility than usual biventricular ventricular assist devices with large and noisy displacement pumps.
authors.affiliation: Deutsches Herzzentrum Berlin, Department of Cardiovascular and Thoracic Surgery, Augustenburger Platz 1, D-13353 Berlin, Germany. krabatsch@dhzb.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Krabatsch
authors.forename: Evgenij
authors.initials: E
authors.lastname: Potapov
authors.forename: Alexander
authors.initials: A
authors.lastname: Stepanenko
authors.forename: Martin
authors.initials: M
authors.lastname: Schweiger
authors.forename: Marian
authors.initials: M
authors.lastname: Kukucka
authors.forename: Michael
authors.initials: M
authors.lastname: Huebler
authors.forename: Ewald
authors.initials: E
authors.lastname: Hennig
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D000328:Adult; D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006353:Heart-Assist Devices / Q000145:classification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000601:surgery; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology / Q000601:surgery