title: Surgical Considerations and Challenges for Bilateral Continuous-Flow Durable Device Implantation.
abstract: The concept of biventricular support with durable centrifugal pumps is evolving, and the surgical strategy and best practice guidelines for implantation of right-sided devices are still unknown. We present optimal strategy for bilateral HeartWare continuous-flow ventricular assist device (HVAD) implantation in a series of four patients. Patients were implanted with the HVAD pumps simultaneously or sequentially. This report offers a perspective on surgical considerations such as right ventricular positioning, implications related to potential risks of obstruction from the tricuspid apparatus, the role if any of downsizing the outflow anastomosis, and considerations for speed adjustments. In this series, one patient died on support and three patients experienced pump thrombosis requiring device revision. All other patients survived until orthotopic heart transplantation, although one of these patients died from perioperative complications, 2 days posttransplantation. Surgical management of patients with medically refractory biventricular heart failure remains challenging and associated with a high incidence of pump thrombosis. Best practice guidelines from experts' consensus are still needed to address this challenging population.
authors.affiliation: From the *Department of Cardiothoracic Surgery, Mayo Clinic, Rochester, Minnesota; †Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; ‡Department of Cardiology, Mayo Clinic, Rochester, Minnesota; and §Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Simon
authors.initials: S
authors.lastname: Maltais
authors.forename: Sara
authors.initials: S
authors.lastname: Womack
authors.forename: Mary E
authors.initials: ME
authors.lastname: Davis
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Danter
authors.forename: Sudhir S
authors.initials: SS
authors.lastname: Kushwaha
authors.forename: John M
authors.initials: JM
authors.lastname: Stulak
authors.forename: Nicholas
authors.initials: N
authors.lastname: Haglund
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012086:Reoperation; D055815:Young Adult