Initial clinical experience of total cardiac replacement with dual HeartMate-II axial flow pumps for severe biventricular heart failure.

Introduction Continuous flow pumps are commonly used to support patients with acute cardiogenic shock and are increasingly used for chronic support in heart failure patients. In the past, pulsatile long-term left ventricular assist devices (LVADs), such as the Novacor and HeartMate-I, provided adequate cardiac support yet they were subject to complications including eventual device failure and infections. With improvements in technology and migration towards axial or continuous flow devices, device miniaturization has become possible, thereby leading to improved anatomical fitting, less vibration and driving noise, and more efficient power consumption. Furthermore, device durability, anti-thrombogenicity, and physiological adaptation to continuous flow pumps appear to be clinically feasible not only for bridge-to-transplant but also for extended longer-term support, namely “destination therapy.”1,2 In cases of severe biventricular heart failure, right heart support may be required in addition to left hear...