Thinkers needed to improve biventricular assist device outcome

摘要

Previous studies have demonstrated poor survival with biventricular assist device support (BIYAD). Analyses from 3 large multicenter databases show the following survivals with BIVAD versus left ventricular assist device support (LVAD): 68% versus 93% at 6 months in the United Network for Organ Sharing registry (n = 408 vs n = 3230),1 50% versus 80% at 1 year in the Interagency Registry for Mechanically Assisted Circulatory Support (n = 358 vs n = 11,672),2 and 53% versus 81 % at 1 year in the International Society for Heart and Lung Transplantation Registry for Mechanically Assisted Circulatory Support (n = 210 vs n = 5509).3The study by Bartfay and colleagues4 in this issue of the Journal challenges this existing knowledge. Although their patients with BIVAD were sicker, the 1-year survival was 85%, comparable to the 86% survival of the patients with LVAD. This remarkable accomplishment was attained not only by their strategy of aggressive BIVAD use but also by their thoughtfulness and creativity, which are exemplified by their use of the ROTAFLOW pump (MAQUET Cardiovascular, LLC, Wayne, NJ) with the EXCOR Cannulas (Berlin Heart GmbH, Berlin, Germany) during the early postoperative period.