Implantation of biventricular assist devices (BVAD) is an accepted therapy for acute cardiac
failure in different settings: post cardiotomy ventricular failure, acute myocardial infarction,
cardiomyopathy or failed transplant. Intended endpoints are bridge to recovery of the
native heart or heart transplantation. Better survival rates are obtained with a growing
experience. Over a 4 year period we implanted the Abiomed BVS 5000 in 20 patients (i.e.
less than 1% of our adult cardiac surgery patients), 17 men and 3 women, with a mean
age of 52,6 years (range 15 to 66) and mean BSA of 1.9 (range 1.7 to 2.2).
One patient was supported by a left ventricular assist device (LVAD), one patient was
initially supported by a right ventricular assist device (RVAD) and 19 patients had a
biventricular support. Indication for BVAD was post-cardiotomy ventricular failure (n=15)
combined with peri-operative acute myocardial infarction in 7 patients, cardiomyopathy
(n=3), failed transplant (n=1) or rheumatic fever (n=1). Ten patients needed
cardiopulmonary resuscitation (CPR) for cardiac arrest prior to installation of extra corporeal
circulation. Mean length of support was 5,4 days (range 2 hours to 13 days). Bleeding
complications requiring re-exploration (n=14) were mostly device related. Other
complications were renal failure (n=10), respiratory failure (n=7), hemolysis (n=6),
neurological deficit (n=4), infection (n=4), Vena Cava Superior syndrome (n=2), ventricular
septal rupture (n=1) and mitral regurgitation (n=1).
Of the 16 patients supported with the intention to recovery of the native heart 4 recovered.
Of the 5 patients with BVAD as bridge to transplantation, 2 were successfully transplanted.
Eight patients (40%) were weaned from the device with the aid of transoesophageal
echocardiographic monitoring but 4 died in hospital one or 2 days after weaning. Ten
patients died on the BVAD, resulting in an overall survival of 30%. Cause of death was
bleeding (n=4), left ventricular failure (n=3), sepsis (n=3), respiratory failure (n=2) and brain
death (n=2). Better survival rates for BVAD patients are seen with growing experience in
patient selection, correct surgical placement and early exploration for bleeding. Possible
recovery of the native heart can best be evaluated by transoesophageal echocardiography.