Abstract 9934: Biventricular Assist Device May be Superior to Left Ventricular Assist Device for Crash and Burn Patients

Abstract

Purpose: Over 15,000 left ventricular assist devices (LVADs; HeartMate I and II) have been implanted world-wide as bridge to transplant or destination in the last decade and appears to be the device of choice. However, the 1 year survival and success to transplant rates are not uniform across the INTERMACS profile spectrum. Current 6 month survival for INTERMACS profile 1 patients undergoing VAD support as bridge to transplant is 60%. We reviewed our more recent experience with both biventricular assist device (BiVAD) and LVAD support to compare the effectiveness and success rates for these two bridging modalities in this critically-ill cohort of patients. Methods: Between Jan 2007 and Mar 2012, we reviewed 56 INTERMACS profile 1 patients. 32 patients who appeared to have adequate right ventricular function received the LVAD (20 HeartMate I and 12 HeartMate II) alone while the remaining 24 patients were supported with a pneumatic BiVAD. Successful bridge to transplant, recovery and ongoing support at 6 months were analyzed among these groups. Results: 21/24 BiVAD patients vs 11/32 LVAD pts (88% vs 34%, p<0.001) were successfully transplanted or explanted due to recovery of cardiac function. Of the LVAD patients, 7/20 HeartMate II patients vs 4/12 HeartMate I patients (35% vs 33%, p=0.93) were successfully transplanted or explanted due to recovery of cardiac function. Multivariate analysis suggested that inotropic support more than 14 days post VAD implantation in LVAD patients was associated with increased mortality. 2/3 BiVAD deaths and 13/21 LVAD deaths were due to progressive shock, hemorrhage or right ventricular failure. 1-year survival post transplant was 18/20 (90%) in the BiVAD group and 11/11 (100%) in the LVAD group. Conclusions: In critically-ill INTERMACS profile 1 transplant candidates, BiVAD support may result in improved outcomes compared to LVAD and could be the device of choice. In these LVAD patients, perceived adequate right ventricular function may be misleading as these are very ill INTERMACS profile 1 patients where subsequent progressive shock, hemorrhage and right ventricular failure are major causes of death.