title: Are biventricular assist devices underused as a bridge to heart transplantation in patients with a high risk of postimplant right ventricular failure?
abstract: Right ventricular failure in patients treated using left ventricular assist devices is associated with poor outcomes. We assessed the strategy of preplanned biventricular assist device implantation in patients with a high risk for right ventricular failure.
  
  
  
  Between 2010 and 2014, we assigned 20 patients to preplanned biventricular assist device and 21 patients to left ventricular assist device as a bridge to heart transplantation on the basis of the estimated risk of postimplant right ventricular failure. Preimplant characteristics and postimplant outcomes were compared between the 2 groups.
  
  
  
  Patients with a biventricular assist device were younger, more often female, and more frequently had nonischemic heart disease than left ventricular assist device recipients. At preoperative assessment, biventricular assist device recipients had poorer Interagency Registry for Mechanically Assisted Circulatory Support profiles, a lower cardiac index, and more compromised right ventricular function. Survival on device to heart transplantation/weaning/destination for biventricular assist device and left ventricular assist device recipients was 90% versus 86% (not significant), with shorter heart transplantation waiting times for biventricular assist device recipients (median days, 154 vs 302, P < .001). Overall survival at 1 year was 85% (95% confidence interval, 62-95) versus 86% (95% confidence interval, 64-95) (not significant). The majority of both biventricular assist device and left ventricular assist device recipients could be discharged to home during the heart transplantation waiting time (55% vs 71%, not significant), and complication rates on device were comparable between groups (major stroke 10% vs 10%, not significant).
  
  
  
  Planned in advance, the biventricular assist device seems to be a feasible option as bridge to heart transplantation for patients with a high risk of postimplant right ventricular failure. The outcomes for these patients were similar to those observed for contemporary left ventricular assist device recipients, despite those receiving biventricular assist devices being more severely ill.
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Sven-Erik
authors.initials: SE
authors.lastname: Bartfay
authors.affiliation: Department of Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Göran
authors.initials: G
authors.lastname: Dellgren
authors.affiliation: Department of Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Lidén
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Mikael
authors.initials: M
authors.lastname: Holmberg
authors.affiliation: Department of Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Jakob
authors.initials: J
authors.lastname: Gäbel
authors.affiliation: Department of Anaesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Redfors
authors.affiliation: Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Odd
authors.initials: O
authors.lastname: Bech-Hanssen
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, University of Gothenburg, Gothenburg, Sweden. Electronic address: kristjan.karason@gu.se.
authors.forename: Kristjan
authors.initials: K
authors.lastname: Karason
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects* / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology / Q000601:surgery*; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: complications; heart failure; survival; transplantation; ventricular assist device