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Review
. 2023 Nov 6:10:1234516.
doi: 10.3389/fcvm.2023.1234516. eCollection 2023.

Current and future options for adult biventricular assistance: a review of literature

Claudia Maria Loardi  1 , Marco Zanobini  2 , Gabriella Ricciardi  3 , Emmanuelle Vermes  4
Affiliations
Review

Current and future options for adult biventricular assistance: a review of literature

Claudia Maria Loardi et al. Front Cardiovasc Med. .

Abstract

In cardiogenic shock various short-term mechanical assistances may be employed, including an Extra Corporeal Membrane Oxygenator and other non-dischargeable devices. Once hemodynamic stabilization is achieved and the patient evolves towards a persisting biventricular dysfunction or an underlying long-standing end-stage disease is present, aside from Orthotopic Heart Transplantation, a limited number of long-term therapeutic options may be offered. So far, only the Syncardia Total Artificial Heart and the Berlin Heart EXCOR (which is not approved for adult use in the United States unlike in Europe) are available for extensive implantation. In addition to this, the strategy providing two continuous-flow Left Ventricular Assist Devices is still off-label despite its widespread use. Nevertheless, every solution ensures at best a 70% survival rate (reflecting both the severity of the condition and the limits of mechanical support) with patients suffering from heavy complications and a poor quality of life. The aim of the present paper is to summarize the features, implantation techniques, and results of current devices used for adult Biventricular Mechanical Circulatory Support, as well as a glance to future options.

Keywords: biventricular assistance; end-stage heart failure; left ventricular assist device; orthotopic heart transplantation; total artificial heart.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor CD declared a past co-authorship with the author EV.

Figures

Figure 1
Figure 1
ImpellaRP. A picture showing ImpellaRP configuration.
Figure 2
Figure 2
TandemHeart. The drawing represents the central placement of TandemHeart for left assistance.
Figure 3
Figure 3
TandemHeart RVAD: central cannulation setup. An inflow cannula is placed in the right atrium and an outflow cannula in the pulmonary artery to achieve right heart assistance. LA, left atrium; LV, left ventricle; PA, pulmonary artery; RA, right atrium; RV, right ventricle.
Figure 4
Figure 4
Syncardia TAH. Some schematic pictures of Syncardia, composed of two artificial ventricles, two outflow grafts and two drivelines. TAH, total artificial heart.
Figure 5
Figure 5
Berlin Heart EXCOR. A picture of Berlin Heart, showing its transparent housing and bileaflet valves.
Figure 6
Figure 6
HeartMate 3. A picture of HeartMate 3 and of its intrathoracic placement.
Figure 7
Figure 7
Two HeartMate 3. The coupling of two HeartMate 3 requiring the cannulation of the right atrium and of the pulmonary artery (for the right device) and of the left ventricular apex and of the aorta (for the left one) allows total cardiac assistance.
Figure 8
Figure 8
CARMAT. CARMAT external aspect showing the bag surrounding the device, the atrial sewing collars, and the outflow grafts.
Figure 9
Figure 9
Flow-chart of biventricular heart failure patients requiring MCS. Short/Mid-term MCS may lead to recovery or bridge to long-term MCS. In a destination-therapy setting, no form of mechanical assistance is currently approved. For BTT patients, two adult devices (one off-label in the US) and a pediatric one are available, each presenting pros and cons highlighting the lack of an optimal solution. ECMO, extracorporeal membrane oxygenator; MCS, mechanical circulatory support; OHT, orthotopic heart transplantation; TAH, total artificial heart; US, United States.
See this image and copyright information in PMC

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