PMC:6640909 / 72225-76252 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/6640909","sourcedb":"PMC","sourceid":"6640909","source_url":"https://www.ncbi.nlm.nih.gov/pmc/6640909","text":"8. SYSTEM SELECTION\n\n8.1 Background\nImplantable CF-LVADs represent the most common form of LT-MCS device used. However, some situations require temporary or permanent biventricular support and outcomes of patients depend on the appropriate choice of MCS strategy.\n\n8.2 Evidence review\n\nCentrifugal versus axial-flow implantable left ventricular assist devices\nThe currently approved axial-flow and centrifugal LVADs provide safe and effective circulatory support in a population of patients with end-stage HF [138–150].\nCentrifugal LVADs may facilitate implantation and offer options for different surgical approaches and strategies [151–154].\n\nLeft ventricular assist device versus biventricular assist device: impact of right heart function\nA combination of clinical, haemodynamic, echocardiographic and biochemical parameters might be useful to assess right heart function preoperatively and to predict the need for perioperative mechanical RV support (Supplementary Material, Table S3).\nLevosimendan prior to LVAD implantation might be used to reduce the risk of right ventricular failure, although evidence is limited [155, 156].\nEchocardiographic assessment of RV geometry, contractility and valvular function (Supplementary Material, Table S4) prior to VAD implantation can be useful to evaluate the need for RV support [157–161].\nPatients with adequate right heart function who only require LVAD support have better survival rates, lower adverse event rates and superior quality of life than patients requiring BiVAD or TAH support [147, 162–173].\nRV failure requiring RVAD support is the most important risk factor for early death in LVAD recipients [170, 174–178].\nTemporary RVAD support should be considered in all recipients of an implantable LVAD, even in case of low RV failure risk score (RVAD required in 6–28% of LVAD recipients) [147, 178].\nDelayed institution or rescue implantation of RV support further increases the risk of morbidity and mortality compared to early RVAD implantation [147, 168, 169, 171, 179].\n\n8.3 Biventricular assist device\nSeveral BiVAD configurations exist: paracorporeal pulsatile-flow BiVAD, an implantable LVAD coupled with a concurrent paracoporeal or percutaneous RVAD or two implantable CF-LVADs. These conficurations provide comparable outcomes [173]. The insertion of two implantable CF-LVADs as BiVAD configuration is predominatly performed at experienced centers. However, the application of a CF-LVAD as an implantable RVAD remains an off-label use.\n\n8.4 Temporary right ventricular assist device\nA temporary RVAD can be used while awaiting recovery of the RV after LVAD implantation and can be substituted with long-term RVAD support if required [170, 180].\nA temporary RVAD can be implanted percutaneously [181, 182] or surgically through a less invasive or sternotomy approach [183–186].\n\n8.5 Longer-term right ventricular assist device\nImplantable BiVAD (e.g. 2 CF-LVADs) support might be considered in patients at high risk of RV failure having bridge to transplant [81, 187–191].\nOff-label use of implantable axial-flow or centrifugal LVADs has been adopted as RVAD support in conjunction with implantable LVAD support as an alternative to extracorporeal BiVAD or TAH implantation [192–196].\n\n8.6 Total artificial heart\nTAH implantation is an option in bridge-to-transplant patients with biventricular failure and provides results comparable to those of BiVAD support [187, 193, 197–202].\nTAH implantation may be considered in patients with anatomical or other conditions that are not well served with 2 implantable LVADs or extracorporeal BiVAD such as in patients with small/non-dilated ventricles or patients requiring significant concomitant repair, e.g. restrictive/hypertrophic cardiomyopathy, cardiac tumour [203–206], complex postinfarction ventricular septal defect [207, 208] and congenital heart disease (CHD) with end-stage HF [209, 210].\nTAH might have a lower stroke incidence compared to BiVAD, resulting in a trend towards better survival [193, 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