The use of biventricular assist devices in end stage chronic heart failure

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Patients with severe biventricular failure are often supported with early generation paracorporeal biventricular assist devices (BiVAD). Compared to durable continuous flow left ventricular assist devices (LVAD), these pulsatile BiVAD systems are decades behind in terms of both design and performance. Therefore the aim of this thesis was to assess the use of two continuous flow LVADs (HeartWare HVAD) for biventricular support. Various aspects of this novel BiVAD system were tested. Pump performance and haemodynamic characteristics were tested using an in-vitro model of the human cardiovascular system, clinical short and long term outcomes were retrospectively reviewed in 14 patients (10 over the course of this thesis), and laboratory assessment was undertaken to evaluate the consequences of BiVAD support on the patients cardiac parameters, particularly on the genetic variations of cardiomyocytes in 7 paired samples (implant vs. explant). Our in-vitro simulations revealed that dual LVAD therapy (BiVAD with two LVADs) was an acceptable form of biventricular support. Interestingly, from a haemodynamic viewpoint, post-LVAD induced right ventricular failure was successfully reversed with delayed RVAD support. In addition, our experiments also revealed successful BiVAD support despite the presence of mitral or tricuspid regurgitation. Our clinical investigations depicted acceptable 1 year survival and high transplantation rates. It also demonstrated an innovative methodology of implanting LVAD in both the right ventricle and right atrium for right ventricular support. The laboratory findings resulted in the development of sound methodology and application of investigatory techniques. However, no differences were found between the up/down regulation of genetic markers pre- and post BiVAD support. Further research in the area is warranted. In conclusion, the use of dual LVAD therapy is an acceptable means of providing durable BiVAD support in patients unsuitable for isolated LVAD therapy.
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