Practice Guideline

. 2025 Aug;45(4):673-682.

doi: 10.1007/s11596-025-00087-3. Epub 2025 Jul 11.

Expert Consensus on Clinical Application of Implantable Biventricular Assist Devices

Nian-Guo Dong^#¹, David D'Alessandro², Jamshid Karimov³, I-Wen Wang⁴, Liang-Wan Chen⁵, Ying-Bin Xiao⁶, Chun-Sheng Wang⁷, Qiang Zhao⁸, Jia-Wei Shi^#⁹, Shun-Zhou Yu¹⁰, Cheng Zhou^#⁹, Pascal Leprince¹¹, Minoru Ono¹², Jan Schmitto¹³, Ming Gong¹⁴, Yong-Feng Shao¹⁵, Xian-Qiang Wang¹⁶, Xing Hao¹⁴, Xiao-Tong Hou¹⁴, Xin Li⁷, Wei Wang¹⁷, Ting Wu¹⁸, Hai-Tao Zhang¹⁹, Cheng-Bin Zhou²⁰, Ping Li⁹, Yin Wang⁹, Yi-Xuan Wang⁹, Jing Zhang⁹; Extracorporeal Life Support Professional Committee, Chinese Medical Doctor Association

Affiliations

¹ Department of Cardiovascular Surgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. dongnianguo@hust.edu.cn.
² Division of Cardiac Surgery, Massachusetts General Hospital, Boston, 02114, USA. DADALESSANDRO@mgh.harvard.edu.
³ Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, 44106, USA. karimoj@ccf.org.
⁴ Division of Cardiac Surgery, Memorial Healthcare System, Hollywood, 33021, USA. IWang@mhs.net.
⁵ Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, China.
⁶ Department of Cardiovascular Surgery, The Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.
⁷ Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
⁸ Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
⁹ Department of Cardiovascular Surgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
¹⁰ Shenzhen Core Medical Technology Co., Ltd., Shenzhen, 518000, China.
¹¹ Department of Cardio-Thoracic Surgery, Pitié-Salpêtrière Hospital, Sorbonne University, 75013, Paris, France.
¹² Department of Cardiothoracic Surgery, The University of Tokyo, Tokyo, 113-8655, Japan.
¹³ Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625, Hannover, Germany.
¹⁴ Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 210029, China.
¹⁵ Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
¹⁶ Department of Cardiac Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
¹⁷ Department of Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
¹⁸ Department of Cardiopulmonary Bypass, Clinical College of Chest, Tianjin Medical University, Tianjin, 300070, China.
¹⁹ Department of Critical Care Medicine, School of Medicine, Shanghai East Hospital, Tongji University, Shanghai, 200127, China.
²⁰ Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangzhou, 510080, China.

^# Contributed equally.

PMID: 40643876
DOI: 10.1007/s11596-025-00087-3

Practice Guideline

Expert Consensus on Clinical Application of Implantable Biventricular Assist Devices

Nian-Guo Dong et al. Curr Med Sci. 2025 Aug.

. 2025 Aug;45(4):673-682.

doi: 10.1007/s11596-025-00087-3. Epub 2025 Jul 11.

Authors

Affiliations

¹ Department of Cardiovascular Surgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. dongnianguo@hust.edu.cn.
² Division of Cardiac Surgery, Massachusetts General Hospital, Boston, 02114, USA. DADALESSANDRO@mgh.harvard.edu.
³ Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, 44106, USA. karimoj@ccf.org.
⁴ Division of Cardiac Surgery, Memorial Healthcare System, Hollywood, 33021, USA. IWang@mhs.net.
⁵ Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, China.
⁶ Department of Cardiovascular Surgery, The Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.
⁷ Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
⁸ Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
⁹ Department of Cardiovascular Surgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
¹⁰ Shenzhen Core Medical Technology Co., Ltd., Shenzhen, 518000, China.
¹¹ Department of Cardio-Thoracic Surgery, Pitié-Salpêtrière Hospital, Sorbonne University, 75013, Paris, France.
¹² Department of Cardiothoracic Surgery, The University of Tokyo, Tokyo, 113-8655, Japan.
¹³ Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625, Hannover, Germany.
¹⁴ Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 210029, China.
¹⁵ Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
¹⁶ Department of Cardiac Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
¹⁷ Department of Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
¹⁸ Department of Cardiopulmonary Bypass, Clinical College of Chest, Tianjin Medical University, Tianjin, 300070, China.
¹⁹ Department of Critical Care Medicine, School of Medicine, Shanghai East Hospital, Tongji University, Shanghai, 200127, China.
²⁰ Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangzhou, 510080, China.

^# Contributed equally.

PMID: 40643876
DOI: 10.1007/s11596-025-00087-3

Abstract

While biventricular assist devices (BiVADs) remain underutilized in Western countries for biventricular heart failure (BHF), their application is expanding in China. This consensus synthesizes international guidelines, medical evidence, and Chinese clinical expertise to establish standardized protocols for BiVAD management. Key recommendations include: (1) Preoperative right heart catheterization and echocardiography for central venous pressure (CVP): pulmonary capillary wedge pressure (PCWP) ratio and pulmonary artery pulsatility index (PAPi) assessment (Class I); (2) BiVAD indication in refractory BHF or high-risk right heart failure post-left ventricular assist device (LVAD) implantation (Class IIa); (3) Right atrial implantation as the preferred surgical approach (Class IIa); (4) Warfarin-based anticoagulation (INR 2.0-2.5) with aspirin, avoiding direct oral anticoagulants (DOACs) (Class III). The guidance addresses critical gaps in patient selection, pump speed titration, and complication management, positioning integrated BiVAD systems as a promising solution for complex BHF.

Keywords: Biventricular assist device; Double heart failure; End-stage heart failure; Heart failure management; Mechanical circulatory support.

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Conflict of interest statement

Declarations. Competing interest: The authors declare that they have no conflicts of interest relevant to the content of this manuscript. Ethical Approval and Consent to Participate: Not applicable. Consent for Publication: Not applicable.

References

1. Working Group on Heart Failure of National Center for Cardiovascular Quality Improvement. 2020 Clinical performance and quality measures for heart failure in China. Chin Circ J (Chinese). 2021;36(3):221–238.
1. Khan MS, Shahid I, Bennis A, et al. Global epidemiology of heart failure. Nat Rev Cardiol. 2024;21(10):717–734. - PubMed
1. Kapelios CJ, Lund LH, Wever-Pinzon O, et al. Right heart failure following left ventricular device implantation: natural history, risk factors, and outcomes: an analysis of the STS INTERMACS database. Circ Heart Fail. 2022;15(6):e008706. - PubMed - PMC
1. Kuroda T, Miyagi C, Fukamachi K, et al. Biventricular assist devices and total artificial heart: Strategies and outcomes. Front Cardiovasc Med. 2023;9:972132. - PubMed - PMC
1. Rajapreyar I, Solliman O, Brailovsky Y, et al. Late right heart failure after left ventricular assist device implantation: contemporary insights and future perspectives. JACC Heart Failure. 2023;11(8 Pt 1):865–878. - PubMed

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Expert Consensus on Clinical Application of Implantable Biventricular Assist Devices

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Expert Consensus on Clinical Application of Implantable Biventricular Assist Devices

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