1. Introduction
From 2009 to 2015, in-hospital mortality and complication rates associated with left ventricular assist device (LVAD) implantation significantly declined.1,2 Much of the favorable outcomes have been attributed to the evolution of mechanical circulatory support from pneumatic mechanical-bearing pulsatile-flow (PF) pumps to magnetically-levitated continuous-flow (CF) devices. According to the latest results from the MOMENTUM 3 trials, 77% of patients receiving the HeartMate III LVAD had a stroke-free 2-year survival.3 Despite these encouraging outcomes, right ventricular failure (RVF) post-LVAD remains a significant cause of adverse outcomes – in some instances requiring biventricular assist devices (BiVADs).4
Despite the advances in LVAD technology, most BiVADs – including total artificial hearts (TAHs) and external BiVADs – are still pneumatic PF devices. BiVAD configurations are diverse and include completely internalized devices – such as the TAH or two separate internal ventricular assist devices (VADs) – and external support, such as paracorporeal PF BiVADs, and CF centrifugal pumps (e.g., CentriMag).5 Given these fundamental differences, it is unknown whether the promising national trends in the LVAD population – improvement in survival, decrease in length of stay (LOS), and reduction in complication rates – also hold true for patients receiving surgically implanted BiVADs. This study is the first to describe the national trends in utilization, mortality, complications, cost, and LOS for patients receiving BiVADs.