From Heart Failure via Biventricular Assist Device to Heart Transplantation

Abstract

Purpose The Berlin Heart® EXCOR biventricular assist device (BVAD) can be used in pediatric as well as adult patients for bridge to heart transplantation (HTX). This study represents the largest population of BVAD implantations in adult patients reported so far. Methods Adult patients (>16 years) receiving a BVAD from 2006-2020 were included. Patient characteristics and outcomes were analyzed in a retrospective single center study. Results Out of the 54 patients, 45 (83%) were male, mean age of 47.4 ± 11.8 years. Mean body mass index (BMI) was 26 kg/m2 with 15 patients >30kg/m2 BMI. INTERMACS classifications were: I =23 patients (43%), II-III = 17 (31%) and IV-V= 14 (26%). Eight patients (14.8) had previous cardiac surgery before BVAD. 30% suffered from ischemic cardiomyopathy. Before BVAD 33 patients (61%) needed temporary MCS (IABP n=14, v-a ECMO n=26; with 7 patients (13%) receiving both). Mean ICU stay after BVAD was 30 days. 26 patients (48%) died on BVAD with mean time to death of 64.6 days. Causes of death were multiple organ failure (27%), septic shock (19%), cerebral hemorrhage (15%), bleeding (11%), cardiogenic shock (11%) and thrombembolic event (8%). In all 54 BVAD patients we performed 83 chamber exchanges. 28 patients were listed as high-urgency (HU) before HTX. Causes for HU-listing were VAD infections (46%, deteriorating HF under BVAD (18%), multiple VAD-related complications (14%), pump thrombosis (7%), stroke (7%), gastrointestinal bleeding (4%) and cardiac arrhythmia (4%). Complications after BVAD and HTX are listed in table 1. Mean time to HTX was 305 days. 30-day-survival after HTX was 96%. 1- and 3-year-mortality were 18 and 30% respectively. Post-HTX causes of death were cardiogenic (27%) and septic shock (36%). Conclusion These retrospective data show secondary organ failure and bleeding represented the main complications under BVAD support. Only 50% of BVAD patients were successfully transplanted but post HTX survival in BVAD patients was comparable to other HTX candidates.