Biventricular assist devices and total artificial heart: Strategies and outcomes

Abstract

In contrast to the advanced development of the left ventricular assist device (LVAD) therapy for advanced heart failure, the mechanical circulatory support (MCS) with biventricular assist device (BVAD) and total artificial heart (TAH) options remain challenging. The treatment strategy of BVAD and TAH therapy largely depends on the support duration. For example, an extracorporeal centrifugal pump, typically referred to as a temporary surgical extracorporeal right ventricular assist device, is implanted for the short term with acute right ventricular failure following LVAD implantation. Meanwhile, off-label use of a durable implantable LVAD is a strategy for long-term right ventricular support. Hence, this review focuses on the current treatment strategies and clinical outcomes based on each ventricle support duration. In addition, the issue of heart failure post-heart transplantation (post-HT) is explored. We will discuss MCS therapy options for post-HT recipients.

Keywords: HeartMate 3®; Impella®; ProtekDuo®; Syncardia® TAH; biventricular heart failure; heart transplantation; left ventricular assist device; right heart failure.

FIGURE 1

Mechanical circulatory support (MCS) devices for right ventricular/biventricular failure. (A) SynCardia^® total artificial heart 70 cc (left) and 50 cc (right), re-use from Villa et al. (60), (B) Aeson^® total artificial heart (Image from Carmat SA, used with permission), (C) Impella RP^® (Image from Impella RP instruction manual, used with permission), and (D) LifeSparc^® pump with ProtekDuo^® cannula (Image from Livanova Investor Day 2021 presentation, used with permission).