Durable BiVAD Support: Configurations, Techniques, and Outcomes

This chapter focuses on durable biventricular circulatory support in the contemporary era of intracorporeal centrifugal continuous flow ventricular assist devices (cf-VADs). In a larger multicenter report of durable biventricular assist devices (BiVADs), nonischemic etiologies represented 80% of the population, followed by ischemic (13%) and other (7%). The overwhelming majority of patients receiving durable BiVAD support in the current era are INTERMACS profile or 2, reflecting the critically ill nature of this population. Median sternotomy is performed with cardiopulmonary bypass instituted using bicaval venous return and high ascending aortic cannulation. The left ventricle apex is exposed and standard left ventricular assist device implantation is performed, with the usual outflow graft anastomosed end-to-side to the mid-ascending aorta. In the current era of BiV-HM3 implantation, infection and bleeding appear to remain significant adverse events.