OBJECTIVE: It is generally accepted that patients who require biventricular assist device support have poorer outcomes than those requiring isolated left ventricular assist device support. However, it is unknown how the timing of biventricular assist device insertion affects outcomes. We hypothesized that planned biventricular assist device insertion improves survival compared with delayed conversion of left ventricular assist device support to biventricular assist device support. METHODS: We reviewed and compared outcomes of 266 patients undergoing left ventricular assist device or biventricular assist device placement at the University of Pennsylvania from April 1995 to June 2007. We subdivided patients receiving biventricular assist devices into planned biventricular assist device (P-BiVAD) and delayed biventricular assist device (D-BiVAD) groups based on the timing of right ventricular assist device insertion. We defined the D-BiVAD group as any failure of isolated left ventricular assist device support. RESULTS: Of 266 patients who received left ventricular assist devices, 99 (37%) required biventricular assist device support. We compared preoperative characteristics, successful bridging to transplantation, survival to hospital discharge, and Kaplan-Meier 1-year survival between the P-BiVAD (n = 71) and D-BiVAD (n = 28) groups. Preoperative comparison showed that patients who ultimately require biventricular support have similar preoperative status. Left ventricular assist device (n = 167) outcomes in all categories exceeded both P-BiVAD and D-BiVAD group outcomes. Furthermore, patients in the P-BiVAD group had superior survival to discharge than patients in the D-BiVAD group (51% vs 29%, P < .05). One-year and long-term Kaplan-Meier survival distribution confirmed this finding. There was also a trend toward improved bridging to transplantation in the P-BiVAD (n = 55) versus D-BiVAD (n = 22) groups (65% vs 45%, P = .10). CONCLUSION: When patients at high risk for failure of isolated left ventricular assist device support are identified, proceeding directly to biventricular assist device implantation is advised because early institution of biventricular support results in dramatic improvement in survival.
OBJECTIVE: It is generally accepted that patients who require biventricular assist device support have poorer outcomes than those requiring isolated left ventricular assist device support. However, it is unknown how the timing of biventricular assist device insertion affects outcomes. We hypothesized that planned biventricular assist device insertion improves survival compared with delayed conversion of left ventricular assist device support to biventricular assist device support. METHODS: We reviewed and compared outcomes of 266 patients undergoing left ventricular assist device or biventricular assist device placement at the University of Pennsylvania from April 1995 to June 2007. We subdivided patients receiving biventricular assist devices into planned biventricular assist device (P-BiVAD) and delayed biventricular assist device (D-BiVAD) groups based on the timing of right ventricular assist device insertion. We defined the D-BiVAD group as any failure of isolated left ventricular assist device support. RESULTS: Of 266 patients who received left ventricular assist devices, 99 (37%) required biventricular assist device support. We compared preoperative characteristics, successful bridging to transplantation, survival to hospital discharge, and Kaplan-Meier 1-year survival between the P-BiVAD (n = 71) and D-BiVAD (n = 28) groups. Preoperative comparison showed that patients who ultimately require biventricular support have similar preoperative status. Left ventricular assist device (n = 167) outcomes in all categories exceeded both P-BiVAD and D-BiVAD group outcomes. Furthermore, patients in the P-BiVAD group had superior survival to discharge than patients in the D-BiVAD group (51% vs 29%, P < .05). One-year and long-term Kaplan-Meier survival distribution confirmed this finding. There was also a trend toward improved bridging to transplantation in the P-BiVAD (n = 55) versus D-BiVAD (n = 22) groups (65% vs 45%, P = .10). CONCLUSION: When patients at high risk for failure of isolated left ventricular assist device support are identified, proceeding directly to biventricular assist device implantation is advised because early institution of biventricular support results in dramatic improvement in survival.
Authors: Nicholas C Dang; Veli K Topkara; Michelle Mercando; Joy Kay; Kurt H Kruger; Michael S Aboodi; Mehmet C Oz; Yoshifumi Naka Journal: J Heart Lung Transplant Date: 2005-12-09 Impact factor: 10.247
Authors: D J Farrar; J D Hill; D G Pennington; L R McBride; W L Holman; R L Kormos; D Esmore; L A Gray; P E Seifert; G P Schoettle; C H Moore; P J Hendry; J N Bhayana Journal: J Thorac Cardiovasc Surg Date: 1997-01 Impact factor: 5.209
Authors: J Raymond Fitzpatrick; John R Frederick; Vivian M Hsu; Elliott D Kozin; Mary Lou O'Hara; Elan Howell; Deborah Dougherty; Ryan C McCormick; Carine A Laporte; Jeffrey E Cohen; Kevin W Southerland; Jessica L Howard; Mariell L Jessup; Rohinton J Morris; Michael A Acker; Y Joseph Woo Journal: J Heart Lung Transplant Date: 2008-12 Impact factor: 10.247
Authors: Kathy E Magliato; Thomas Kleisli; Harmik J Soukiasian; Robert Tabrizi; Bernice Coleman; Ann Hickey; Lawrence S C Czer; Carlos Blanche; Wen Cheng; Gregory P Fontana; Robert M Kass; Sharo S Raissi; Alfredo Trento Journal: ASAIO J Date: 2003 Jul-Aug Impact factor: 2.872
Authors: Vivek Rao; Mehmet C Oz; Margaret A Flannery; Katharine A Catanese; Michael Argenziano; Yoshifumi Naka Journal: J Thorac Cardiovasc Surg Date: 2003-04 Impact factor: 5.209
Authors: Yoshie Ochiai; Patrick M McCarthy; Nicholas G Smedira; Michael K Banbury; Jose L Navia; Jingyuan Feng; Amy P Hsu; Michael L Yeager; Tiffany Buda; Katherine J Hoercher; Michael W Howard; Masami Takagaki; Kazuyoshi Doi; Kiyotaka Fukamachi Journal: Circulation Date: 2002-09-24 Impact factor: 29.690
Authors: R L Kormos; T A Gasior; A Kawai; S M Pham; S Murali; B G Hattler; B P Griffith Journal: J Thorac Cardiovasc Surg Date: 1996-04 Impact factor: 5.209
Authors: Pavan Atluri; Andrew B Goldstone; Alex S Fairman; John W MacArthur; Yasuhiro Shudo; Jeffrey E Cohen; Alexandra L Acker; William Hiesinger; Jessica L Howard; Michael A Acker; Y Joseph Woo Journal: Ann Thorac Surg Date: 2013-06-21 Impact factor: 4.330