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.