Implant of left ventricular assist device in patients at risk of right ventricular failure: role of a temporary biventricular support planned

Background. When patients at high risk for failure of isolated left ventricular assist device (LVAD) support are identified, biventricular assist device implantation is suggested as a primary option. Results of a planned temporary right ventricular mechanical support (RVAD) placement in high-risk LVAD recipients have been reported and analyzed. Methods. Between 2009 and 2011, 10 consecutive adult patients (9 men; age range 31-69 years), with preoperative evidence of moderate to severe biventricular failure, were supported simultaneously with an axial flow HeartMate II (Thoratec Corp., Pleasanton, California) LVAD and a temporary CentriMag (Levitronix LCC, Waltham, Massachusetts) RVAD as a primary option at our institution. Indications for support at implantation were ischemic dilated cardiomyopathy in 6 cases and idiopathic dilated cardiomyopathy in 4. Planned temporary RVAD insertion was defined as RVAD support placement at the same time as LVAD placement. Results. Nine patients were successfully weaned from temporary RVAD support after an average time of 18.6 days (range 3-43 days) and discharged from hospital. One patient died due to respiratory failure. RVAD removal was performed through a minimally invasive approach without repeat sternotomy in 6 patients. None of the patients required a permanent RVAD support. Conclusions. When patients at high risk for failure of isolated LVAD support are identified, temporary biventricular assist device implantation is advised to improve the outcome of such a vulnerable patient population.