What does this research mean for the field?

Implantable biventricular assist device support using off-label continuous-flow left ventricular assist devices achieves feasible bridge-to-transplantation with acceptable long-term survival, but carries a high incidence of serious adverse events including stroke and pump thrombosis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

November 4, 2025Circulation ReportsOpen Access

Long-Term Implantable Biventricular Assist Device Support ― Experience of 6 Cases ―

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Why the study?

Managing heart failure complicated by severe right heart failure with implantable mechanical circulatory support is challenging, and available data on implantable BiVAD support remain limited.

Structured PICO

Population

6 patients with heart failure complicated by severe right heart failure, mean age 31±11 years, 33% male, treated at Osaka University Hospital.

Intervention

Implantable biventricular assist device (BiVAD) support using off-label implantable left ventricular assist devices (Jarvik2000 in 4 patients, HVAD in 2 patients) as right ventricular assist devices.

Outcome

Survival rates at 1 and 3 years after BiVAD implantationhard clinical

Implantable BiVAD support using off-label LVADs is a feasible bridge to transplantation for severe right heart failure, though it carries a high complication burden.

Implication

Implantable BiVAD support may be feasible in select patients; leaves open the need for larger studies to guide selection and outcomes.

Abstract

Background: Managing heart failure complicated by severe right heart failure with implantable mechanical circulatory support remains a significant challenge. One therapeutic strategy is biventricular assist device (BiVAD) support, typically involving the off-label use of 2 implantable left ventricular assist devices (LVADs). Because the available data of implantable BiVAD support remain limited, we reviewed the data for 6 patients on implantable BiVAD support. Methods and Results: Between January 2010 and March 2019, 6 patients underwent BiVAD implantation at Osaka University Hospital. Their mean age was 31±11 years, and 2 (33%) were male. The right ventricular assist devices (RVADs) utilized were Jarvik2000 (Jarvik Heart, NY, USA) in 4 patients (67%), and HVAD (HeartWare, Framingham, MA, USA) in 2 patients (33%). The survival rates at 1 and 3 years after BiVAD implantation were 83% and 67%, respectively. Of the 6 patients, 4 underwent heart transplantation at 553, 709, 791, and 1,245 days, respectively, following RVAD implantation; 2 patients died during follow-up at 280 and 511 days, respectively, after RVAD implantation. Stroke occurred in 3 patients. Hemolysis or pump thrombosis occurred in 3 patients. Heart failure occurred in 3 patients. Device-related infection occurred in 1 patient. Conclusions: Although implantable BiVAD support provided a feasible bridge to transplantation with favorable survival, the high incidence of complications indicates that significant challenges remain in optimizing patient outcomes and emphasizes the necessity for RV-specific device development.