Biventricular assist devices

While left ventricular assist devices (LVADs) are common treatment for patients with heart failure, a sizeable portion of LVAD recipients demonstrate clinically significant postoperative right ventricular failure and potentially require a biventricular assist device (BiVAD). This chapter presents a summary of BiVAD requirements and then reviews several devices that have been used clinically. The majority of these devices are first-generation, pulsatile, paracorporeal systems that are large and unsuitable for long-term support with complications such as device failure, thrombus formation, infection, and severely reduced patient mobility. With the development of rotary blood pumps, more reliable BiVAD options are entering the clinical arena. However, most of these devices have been developed for LVAD support and require modifications for BiVAD support. Although these systems may offer a longer term, completely implantable option for patients with biventricular failure, their control strategies and implantation techniques must be refined. Several BiVAD-specific devices are reported to be under development, yet the advantages of such systems will not be realized until they are implanted in patients and clinicians have gained significant experience using them.