Abstract
Congratulations to the authors [1]. It is refreshing to find an article in the field of mechanical circulatory support that is scientifically sound and honestly presents a contemporary experience that challenges the current wave of enthusiasm for supporting everyone with continuous-flow left ventricular assist devices (LVADs). This experience is exclusively with pulsatile paracorporeal devices, LVADs and biventricular assist devices (BIVADs). The BIVADs are assist, not replacement, devices. The authors selected BIVAD support preemptively in over half of their patient population and did equally well with the BIVAD group as with the LVADs, even though there was a consistent trend for BIVAD patients to be sicker before implantation (blood urea nitrogen levels higher, INTERMACS [Interagency Registry for Mechanically Assisted Circulatory Support] status sicker, more use of inotropic agents, ejection fraction lower).
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