Timing and Outcomes of Concurrent and Sequential Biventricular Assist Device Implantation: A Society of Thoracic Surgeons Intermacs Analysis

Biventricular heart failure remains a clinically challenging condition to manage. Available literature describing durable biventricular (BiVAD) utilization has numerous limitations hindering the development of useful treatment algorithms. Analysis of BiVAD use within a large multicenter dataset is needed to clarify outcomes associated with this therapy.The STS INTERMACS database was queried to identify adults≥18 years who received durable circulatory support from 1/1/10 - 12/31/20. The data set was divided into the following cohorts: 1) left ventricular assist device (LVAD) only (n=27,325), 2) LVAD and concurrent right ventricular assist device (RVAD) (n=1090), 3) LVAD and sequential RVAD (n=556). Propensity score matching was used to compare 1-year mortality and adverse events between concurrent concurrent (n=565) and sequential BiVADs (n=565).Overall survival within one-year was significantly worse for BiVADs in comparison to the LVAD only cohort (12-month survival 50.8% vs 82.6%; p (log-rank) < 0.001). In a propensity matched cohort, patients implanted with a BiVAD concurrently had an improved survival compared to those implanted an LVAD and an RVAD sequentially (12-month survival 55.8% vs 41.8%; p (log-rank) < 0.001). Early (<3 months) adverse event rates were higher among patients receiving sequential BiVADs for bleeding, infection, neurological dysfunction, and renal dysfunction (p-value <0.01).After matching for patient and disease characteristics, patients with sequential BiVAD implantation have worse outcomes than patients with concurrent BiVAD implantation.