Continuous‐Flow Left Ventricular Assist Devices in Biventricular Configuration: A Systematic Review and Comparative Meta‐Analysis of HeartMate 3 and HeartWare Biventricular Assist Devices

Background Advanced biventricular heart failure may require durable biventricular assist device (BiVAD) support when heart transplantation is not immediately feasible or patients are ineligible for heart transplantation. We aimed to compare baseline characteristics, perioperative features, and clinical outcomes between patients supported with HeartMate 3‐BiVAD (HM3‐BiVAD) and HeartWare‐BiVAD (HW‐BiVAD). Methods A systematic search was performed in October 2025 across MEDLINE, Embase, Cochrane Library, Scopus, and CINAHL. We identified studies of adult patients supported with dual HeartMate 3 LVAD and HeartWare HVAD continuous‐flow pumps in a BiVAD configuration. Study‐level data were pooled to compare patients supported with HM3‐BiVAD and those with HW‐BiVAD. Results The proportion of females was significantly lower among HM3‐BiVAD patients [HM3: 4.8% (95% CI: 1.2, 17.1) vs. HW: 22.5% (16.8, 29.4), p = 0.02], whereas patient age was comparable between groups [HM3: 47 (43, 52) years vs. HW: 48 (45, 50) years, p = 0.9]. Chronic kidney disease [HM3: 57.1% (23, 85.6) vs. HW: 10.9% (4.6, 23.6), p = 0.01] was more common among HM3‐BiVAD patients. Concomitant right ventricular assist device (RVAD) placement was the predominant approach across both groups [HM3: 66.2% (35.5, 87.4) vs. HW: 78.5% (70.1, 85), p = 0.36]. Right atrium was used more frequently as RVAD implantation site in the HM3‐BiVAD group [HM3: 96.7% (63.4, 99.8) vs. HW: 33.9% (19, 52.9), p = 0.01], whereas the right ventricle predominated in the HW‐BiVAD group [HM3: 3.2% (0.2, 36.6) vs. HW: 64.5% (45.2, 80.1), p = 0.01]. Overall survival was significantly higher among HM3‐BiVAD patients [78.1% (49.3, 92.9)] compared to HW‐BiVAD patients [48% (40.6, 55.4); p = 0.05]. The mean follow‐up was 274 (200, 349) days in patients with HM3‐BiVAD and 210 (143, 277) days in HW‐BiVAD patients ( p = 0.21). Conclusion Patients with HW‐BiVAD were characterized by a higher proportion of females and more frequent use of the RV as the RVAD implantation site, likely both due to the smaller device profile. HM3‐BiVAD patients demonstrated higher post‐implant survival despite a more severe preimplant clinical profile, suggesting a possible device‐related advantage.