Objective: Patients suffering from severe bi-ventricular failure were traditionally considered for implantation of bi-ventricular assist devices (BIVAD) support as bridge to heart transplantation. The only available long-term BIVAD for the past 25 years has been Thoratec's extra-corporeal pneumatic BIVAD, which has gradually become obsolete due to its high incidence of complications. Since 1992 70 patients underwent VADs implantation at the Sheba Medical Center: 55 LVAD and 15 BIVAD. We have recently implanted the first Israeli patient with HeartWare's centrifugal continuous flow BIVAD as a total artificial heart (TAH).
Case history: The 48 year old woman suffered from dilated cardiomyopathy since the age of 28. She gradually went into NYHA class III bi-ventricular failure and was listed for heart transplantation since 2004, but due to temporary improvement in her condition she declined an offer for a heart donor in 2011. Her bi-ventricular heart failure has further deteriorated in early 2013 and she was admitted as top priority transplant candidate on continuous dobutamine therapy. Due to continuous rapid deterioration in her condition she underwent in August 2013 a HeartWare BIVAD implantation with tricuspid annuloplasty, however poor flows in the RVAD necessitated supporting her on an extracorporeal membrane oxygenator for 48 hours. She was then returned to the operating room and the BIVAD was implanted as a TAH after performing complete bi-ventriculectomy to the level of both atrio-ventricular valves.
The patient recovered slowly from the TAH implantation and was discharged home two months after surgery with both pumps outputs of 5 liters per minute. She has resumed her regular daily activities at home and continues to be listed as top priority for heart transplantation.
Conclusion : Implantation of continuous flow BIVAD as a TAH is a viable solution to patients with severe bi-ventricular failure in whom BIVAD implantation alone is insufficient.
