The BiVAD experience at the university hospital, results from the years 2010 to 2012 and comparison with contemporary LVAD patients

Abstract

Introduction: In our centre there has been an increased use of BiVAD as bridge to heart transplantation (HTx) in patients with advanced biventricular heart failure. The survival rates after BiVAD implantation, earlier described in the literature, have mostly been dismal. It can also be difficult to predict the need for BiVAD instead of LVAD in the individual patient. The aim of our study was to describe the characteristics of our BIVAD patients and compare them with contemporary LVAD patients in respect to results and preoperative characteristics. Patients and methods: During the period 2010-2012, 11 patients were implanted with the Excor BiVAD-system (Berlin Heart Excor) at the University Hospital (mean age 39 years, 73% male). All patients were in severe biventricular heart failure (mean CI 1,5 l/min x sqm, RAP 14 mmHg, PCWP 27 mmHg) and either on waiting list for transplantation or considered suitable for heart transplantation later on. BiVAD patients were compared to the contemporary 12 LVAD patients. Two different RV risk failure scores have also been calculated for each patient and will be discussed. Results: 10/11 patients (91%) survived to HTx. The mean time of stay in the ICU after BiVAD implantation was 10 days and the mean time on assist 148 days. 9/11 patients were in INTERMACS class 1 or 2, 2/11 were in INTERMACS class 3. None of them had ischemic heart disease as the cause of heart failure. In comparison, LVAD patients (Heart Mate II, Thoratec) were older (mean age 56 years), had more ischemic heart disease (50%) and were all male. The survival rate was similar (10/12 patients, 83%) and so was the mean time of stay in the ICU (15 days). The LVAD patients had significantly better RV longitudinal function (measured by tissue Doppler), higher right ventricular stroke work index (RVSWI), higher cardiac index (1,9 l/min x sqm) and lower risk score for RV failure. Three patients had significant RV failure after LVAD implantation and two of those had to be bridged with RVAD. Conclusion: Biventricular assist device is a good treatment option in selected patients with advanced biventricular heart failure. Although our population is small the results in this very sick group of patients are much more encouraging than earlier described. Our results also suggest that the use of BiVAD has been reasonable in relation to the characteristics of our patients.