title: Outcomes of contemporary mechanical circulatory support device configurations in patients with severe biventricular failure.
abstract: OBJECTIVE
  Severe right ventricular failure often is considered a contraindication for left ventricular assist device (LVAD) therapy and necessitates use of biventricular assist devices (BiVADs). Available options for BiVADs are limited, and comparative outcomes are largely unknown.
  
  
  METHODS
  Heart transplant candidates who were registered on the United Network for Organ Sharing waitlist and underwent long-term contemporary LVAD (n = 3195) or BiVAD (n = 408) implantation, from January 2010 through June 2014, were retrospectively analyzed. We evaluated clinical characteristics and outcomes of patients requiring a BiVAD, as well as regional differences in utilization of this technology.
  
  
  RESULTS
  Patients requiring a BiVAD were younger (48.9 vs 53.3 years), had a higher proportion of nonischemic disease (69.1% vs 58.2%), a higher bilirubin level (0.9 vs 0.7 mg/dL), and a lower 6-month survival rate (68.1% vs 92.7%) after device implantation (all P < .05). Postimplantation and posttransplantation survival was comparable for commonly used BiVAD configurations, including total artificial heart, continuous flow BiVAD, a continuous-flow LVAD coupled with a right-sided device, and pulsatile flow. Significant variation was found in regional utilization of these devices, regardless of differences in transplantation waitlist times. A large body surface area was an independent predictor of mortality on a BiVAD (hazard ratio = 2.12, P = .017).
  
  
  CONCLUSIONS
  Outcomes of patients requiring a BiVAD remain poor in the contemporary device era, regardless of the configuration used. Among other clinical factors, body surface area should be incorporated into decision making for device selection in these patients.
authors.affiliation: Division of Cardiology, Department of Medicine, New York-Presbyterian/ Columbia University Medical Center, New York, NY.
authors.forename: Allison P
authors.initials: AP
authors.lastname: Levin
authors.affiliation: Division of Cardiology, Department of Medicine, New York-Presbyterian/ Columbia University Medical Center, New York, NY.
authors.forename: Natalia
authors.initials: N
authors.lastname: Jaramillo
authors.affiliation: Division of Cardiology, Department of Medicine, New York-Presbyterian/ Columbia University Medical Center, New York, NY.
authors.forename: A Reshad
authors.initials: AR
authors.lastname: Garan
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, New York-Presbyterian/ Columbia University Medical Center, New York, NY.
authors.forename: Koji
authors.initials: K
authors.lastname: Takeda
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, New York-Presbyterian/ Columbia University Medical Center, New York, NY.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.affiliation: Division of Cardiology, Department of Medicine, New York-Presbyterian/ Columbia University Medical Center, New York, NY.
authors.forename: Melana
authors.initials: M
authors.lastname: Yuzefpolskaya
authors.affiliation: Division of Cardiology, Department of Medicine, New York-Presbyterian/ Columbia University Medical Center, New York, NY.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, New York-Presbyterian/ Columbia University Medical Center, New York, NY.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.affiliation: Division of Cardiology, Department of Medicine, New York-Presbyterian/ Columbia University Medical Center, New York, NY.
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
authors.affiliation: Division of Cardiology, Department of Medicine, New York-Presbyterian/ Columbia University Medical Center, New York, NY. Electronic address: vt2113@cumc.columbia.edu.
authors.forename: Veli K
authors.initials: VK
authors.lastname: Topkara
mesh_terms: D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000401:mortality; D058409:Cardiac Resynchronization Therapy Devices; D004867:Equipment Design; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016027:Heart Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D014850:Waiting Lists
keywords: biventricular support; right ventricular failure; ventricular assist device