title: Long-term biventricular HeartWare ventricular assist device support--Case series of right atrial and right ventricular implantation outcomes.
abstract: BACKGROUND
  There is limited information on outcomes using the HeartWare ventricular assist device (HVAD; HeartWare, Framington, MA) as a biventricular assist device, especially with respect to site of right ventricular assist device (RVAD) implantation.
  
  
  METHODS
  Outcomes in 13 patients with dilated cardiomyopathy and severe biventricular failure who underwent dual HVAD implantation as bridge to transplantation between August 2011 and October 2014 were reviewed.
  
  
  RESULTS
  Of 13 patients, 10 were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Level 1, and 3 were INTERMACS Level 2. Mean age was 45 ± 11 years, and mean body mass index was 26 ± 4 kg/m(2). There were 7 patients on temporary mechanical support pre-operatively (extracorporeal life support, n = 5; intra-aortic balloon pump, n = 2). The median hospital length of stay was 53 days (interquartile range [IQR] 33-70 days) with a median intensive care unit length of stay of 14 days (IQR 8-36 days). The median length of support on device was 269 days (IQR 93-426 days). The right HVAD was implanted in the right ventricular (RV) free wall in 6 patients and in the right atrial (RA) free wall in 7 patients. Transplantation was successfully performed in 5 patients, and overall survival for the entire cohort was 54%. RVAD pump thrombosis occurred in 3 of 6 RV pumps and 1 of 7 RA pumps. No left ventricular assist device pump thrombosis was observed. Bleeding tended to be higher in the RV implantation group (3 of 6 vs 0 of 7). During follow up, 6 patients died (4 of 7 in the RA group vs 2 of 6 in the RV group). Cause of death was multiple-organ failure in 3 patients, sepsis in 2 patients, and intracerebral hemorrhage in 1 patient.
  
  
  CONCLUSIONS
  Critically ill patients who require biventricular support can be successfully bridged to transplant using 2 HVADs. RA implantation may allow right heart support with lower pump thrombosis and bleeding complications, although this was at the expense of a higher mortality in this cohort.
authors: Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Ultimo; Heart Transplant Unit, St. Vincent's Hospital, Darlinghurst.
authors: Sajad
authors: S
authors: Shehab
authors: Heart Transplant Unit, St. Vincent's Hospital, Darlinghurst; Victor Chang Cardiac Research Institute, Darlinghurst; Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia.
authors: Peter S
authors: PS
authors: Macdonald
authors: Heart Transplant Unit, St. Vincent's Hospital, Darlinghurst; Victor Chang Cardiac Research Institute, Darlinghurst; Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia.
authors: Anne M
authors: AM
authors: Keogh
authors: Heart Transplant Unit, St. Vincent's Hospital, Darlinghurst; Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia.
authors: Eugene
authors: E
authors: Kotlyar
authors: Heart Transplant Unit, St. Vincent's Hospital, Darlinghurst; Victor Chang Cardiac Research Institute, Darlinghurst; Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia.
authors: Andrew
authors: A
authors: Jabbour
authors: Heart Transplant Unit, St. Vincent's Hospital, Darlinghurst.
authors: Desiree
authors: D
authors: Robson
authors: Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Ultimo; Heart Transplant Unit, St. Vincent's Hospital, Darlinghurst.
authors: Phillip J
authors: PJ
authors: Newton
authors: Heart Transplant Unit, St. Vincent's Hospital, Darlinghurst.
authors: Sriram
authors: S
authors: Rao
authors: Heart Transplant Unit, St. Vincent's Hospital, Darlinghurst; Victor Chang Cardiac Research Institute, Darlinghurst; Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia.
authors: Louis
authors: L
authors: Wang
authors: Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Ultimo.
authors: Sabine
authors: S
authors: Allida
authors: Heart Transplant Unit, St. Vincent's Hospital, Darlinghurst.
authors: Mark
authors: M
authors: Connellan
authors: Heart Transplant Unit, St. Vincent's Hospital, Darlinghurst.
authors: Emily
authors: E
authors: Granger
authors: Heart Transplant Unit, St. Vincent's Hospital, Darlinghurst.
authors: Kumud
authors: K
authors: Dhital
authors: Heart Transplant Unit, St. Vincent's Hospital, Darlinghurst.
authors: Phillip
authors: P
authors: Spratt
authors: Heart Transplant Unit, St. Vincent's Hospital, Darlinghurst.
authors: Paul C
authors: PC
authors: Jansz
authors: Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Ultimo; Heart Transplant Unit, St. Vincent's Hospital, Darlinghurst; Victor Chang Cardiac Research Institute, Darlinghurst; Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia. Electronic address: cshayward@stvincents.com.au.
authors: Christopher S
authors: CS
authors: Hayward
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000503:physiopathology*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
keywords: biventricular ventricular assist device; chronic mechanical circulatory support; outcomess; severe heart failure; thrombosis