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Biventricular Assist Devices: A Technical Review

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Abstract

The optimal treatment option for end stage heart failure is transplantation; however, the shortage of donor organs necessitates alternative treatment strategies such as mechanical circulatory assistance. Ventricular assist devices (VADs) are employed to support these cases while awaiting cardiac recovery or transplantation, or in some cases as destination therapy. While left ventricular assist device (LVAD) therapy alone is effective in many instances, up to 50% of LVAD recipients demonstrate clinically significant postoperative right ventricular failure and potentially need a biventricular assist device (BiVAD). In these cases, the BiVAD can effectively support both sides of the failing heart. This article presents a technical review of BiVADs, both clinically applied and under development. The BiVADs which have been used clinically are predominantly first generation, pulsatile, and paracorporeal systems that are bulky and prone to device failure, thrombus formation, and infection. While they have saved many lives, they generally necessitate a large external pneumatic driver which inhibits normal movement and quality of life for many patients. In an attempt to alleviate these issues, several smaller, implantable second and third generation devices that use either immersed mechanical blood bearings or hydrodynamic/magnetic levitation systems to support a rotating impeller are under development or in the early stages of clinical use. Although these rotary devices may offer a longer term, completely implantable option for patients with biventricular failure, their control strategies need to be refined to compete with the inherent volume balancing ability of the first generation devices. The BiVAD systems potentially offer an improved quality of life to patients with total heart failure, and thus a viable alternative to heart transplantation is anticipated with continued development.

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Acknowledgments

The authors would like to acknowledge the assistance from the staff of the mentioned biventricular assist device companies for providing details and images to be used in this article. Dr. Timms and Dr. Fraser report being employees of BiVACOR Pty Ltd with equity ownership in the company. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Authors and Affiliations

  1. School of Engineering Systems and Medical Device Domain, Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia

    Shaun D. Gregory

  2. Critical Care Research Group, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia

    Shaun D. Gregory, Daniel Timms, Nicholas Gaddum, David G. Mason & John F. Fraser

  3. BiVACOR Pty Ltd., Brisbane, QLD, Australia

    Daniel Timms & John F. Fraser

  4. Graduate School of Biomedical Engineering, University of New South Wales, Sydney, NSW, Australia

    Nicholas Gaddum

  5. Dept ITEE, University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia

    David G. Mason

  6. Department of Intensive Care Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia

    John F. Fraser

Authors
  1. Shaun D. Gregory
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  2. Daniel Timms
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  3. Nicholas Gaddum
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  4. David G. Mason
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  5. John F. Fraser
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Corresponding author

Correspondence to Shaun D. Gregory.

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Associate Editor Stefan Jockenhoevel oversaw the review of this article.

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Gregory, S.D., Timms, D., Gaddum, N. et al. Biventricular Assist Devices: A Technical Review. Ann Biomed Eng 39, 2313–2328 (2011). https://doi.org/10.1007/s10439-011-0348-8

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  • DOI: https://doi.org/10.1007/s10439-011-0348-8

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