title: Survival after biventricular mechanical circulatory support: does the type of device matter?
abstract: BACKGROUND
  Biventricular support can be achieved using paracorporeal biventricular assist devices (BiVADs), the total artificial heart (TAH), and implantable VADs. This study evaluated the influence of the device on patient survival.
  
  
  METHODS
  Data from 383 patients (321 men [84%]) undergoing primary, planned biventricular support using durable devices between 2000 and 2010 were extracted from the French multicentric Groupe de Réflexion sur l'Assistance Mécanique (GRAM) registry. Mean age was 41.6 ± 14.0 years. Patients were classified as group 1, 255 (67%) with paracorporeal BiVADs; group 2, 90 (24%) with TAH; and group 3, 38 (10%) with implantable BiVADs.
  
  
  RESULTS
  Mean patient support duration was 82.8 ± 107.4 days and similar among groups (p = 0.53). Bridging to transplantation was successful in 211 patients (55%) and to recovery in 23 (6%). Mortality on device was similar among groups (p = 0.16). TAH patients had a significantly lower stroke rate (p < 0.0001). Actuarial estimates for survival while on support were 75.2% ± 2.3%, 64.4% ± 2.7%, 61.1% ± 2.8%, and 56.8% ± 3.1% at 30, 60, 90, and 180 days, respectively, and were similar among groups. However, TAH patients undergoing prolonged support (≥90 days) showed a trend toward improved survival (p = 0.08). Actuarial post-transplant survival estimates were, respectively, 81.7 ± 2.7, 75.3 ± 3.0, 73.0 ± 3.0, and 64.7 ± 3.7 at 1 month and 1, 3, and 5 years and were similar among groups (p = 0.84).
  
  
  CONCLUSIONS
  Survival while on support and after heart transplantation did not differ significantly in patients supported with paracorporeal BiVADs, implantable BiVADs, or the TAH. Patients undergoing prolonged support (>90 days) tended to have improved survival when supported with TAH compared with BiVADs, which may be related to a lower incidence of neurologic events.
authors.affiliation: Department of Heart Surgery at Institut de Cardiologie, Hôpital La Pitié-Salpétrière, Paris, France. matthias.kirsch@psl.aphp.fr
authors.forename: Matthias
authors.initials: M
authors.lastname: Kirsch
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Mazzucotelli
authors.forename: Jean-Christian
authors.initials: JC
authors.lastname: Roussel
authors.forename: Olivier
authors.initials: O
authors.lastname: Bouchot
authors.forename: Joseph
authors.initials: J
authors.lastname: N'loga
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Litzler
authors.forename: André
authors.initials: A
authors.lastname: Vincentelli
mesh_terms: D000328:Adult; D058409:Cardiac Resynchronization Therapy Devices / Q000145:classification*; D005260:Female; D005602:France; D006331:Heart Diseases / Q000401:mortality* / Q000628:therapy*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014850:Waiting Lists