Hybrid durable biventricular assist device implantation with Berlin Heart EXCOR pulsatile RVAD and a continuous flow LVAD

BACKGROUND: Biventricular failure or right ventricular failure (RVF) after continuous-flow left ventricular assist device (cf-LVAD) implantation is associated with high mortality. Durable right ventricular assist device (RVAD) options are limited, particularly for patients with critical cardiogenic shock or late-onset RVF. Use of right-sided cf-LVAD is costly, complex, and off-label. This study explores a hybrid VAD approach, combining a cf-LVAD and a Berlin Heart EXCOR pulsatile RVAD. METHODS: This multicenter retrospective analysis included patients who received a cf-LVAD with an EXCOR RVAD at six centers in Germany between December 2017 and January 2024. Nineteen patients were analyzed. Baseline demographics, implantation strategy, duration of support, survival, and end-organ function were assessed. RESULTS: Among the 19 patients, 73.7% were male, with a median age of 52 years (IQR 30.5-59.5). Seventeen (89.5%) patients initially presented in INTERMACS level 1 and 14 patients underwent stabilization with temporary mechanical circulatory support before durable VAD implantation resulting in a shift to INTERMACS level 3. Simultaneous LVAD and RVAD implantation occurred in 13 (68.4%) patients. Median hybrid support duration was 112 days (range 9 - 1363 days). One-year mortality was 21.1% overall and 14.3% in patients with simultaneous BIVAD implantation. Improved renal and hepatic function was observed, particularly in patients with simultaneous biventricular support. CONCLUSION: Hybrid support using a cf-LVAD with an EXCOR RVAD is a feasible and effective strategy for patients with biventricular failure. This approach demonstrated favorable survival, especially with simultaneous implantation, and was associated with improved end-organ function.