[Left ventricular assist device recipients at risk of right ventricular failure: the role of a planned temporary biventricular support]

Antonio Loforte, Paola Lilla Della Monica, Andrea Montalto, Francesco Musumeci
Giornale Italiano di Cardiologia 2011, 12 (12): 839-45

BACKGROUND: When patients at high risk for failure of isolated left ventricular assist device (LVAD) support are identified, biventricular assist device implantation is suggested as a primary option. Results of a planned temporary right ventricular mechanical support (RVAD) placement in high-risk LVAD recipients have been reported and analyzed.

METHODS: Between 2009 and 2011, 10 consecutive adult patients (9 men; age range 31-69 years), with preoperative evidence of moderate to severe biventricular failure, were supported simultaneously with an axial flow HeartMate II (Thoratec Corp., Pleasanton, California) LVAD and a temporary CentriMag (Levitronix LCC, Waltham, Massachusetts) RVAD as a primary option at our institution. Indications for support at implantation were ischemic dilated cardiomyopathy in 6 cases and idiopathic dilated cardiomyopathy in 4. Planned temporary RVAD insertion was defined as RVAD support placement at the same time as LVAD placement.

RESULTS: Nine patients were successfully weaned from temporary RVAD support after an average time of 18.6 days (range 3-43 days) and discharged from hospital. One patient died due to respiratory failure. RVAD removal was performed through a minimally invasive approach without repeat sternotomy in 6 patients. None of the patients required a permanent RVAD support.

CONCLUSIONS: When patients at high risk for failure of isolated LVAD support are identified, temporary biventricular assist device implantation is advised to improve the outcome of such a vulnerable patient population.

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