Bridge to transplant using BIVAD or total artificial heart: is there a survival difference?

Biventricular support can be achieved using ventricular assist devices (BiVADs) or total artificial heart (TAH). The purpose of the present study was to compare survival between these two devices. We retrospectively reviewed data from two French teaching hospitals (Henri Mondor Hospital and La Pitié-Salpêtrière Hospital) working in the same geographic area. We identified 140 patients undergoing primary, planned biventricular support using durable devices between 1996 and 2009. There were 122 (87%) males and mean age was 44.0±13.4 years. Sixty-seven patients (48%) received a BiVAD (Henri Mondor Hospital) and seventy-three (52%) patients underwent a TAH (Pitié-Salpêtrière Hospital). Preoperatively, BiVAD recipients had significantly higher ALAT (463.7±962 vs 111±174, p=0.006) and ASAT levels (550.5±1114 vs 158.9±274 p=0.009). TAH recipients had higher rates of previous cardiac surgery (23% vs 3%, p=0.001) and preimplant ECLS (22% vs 0%, p=0.0001). Mean duration of support was 79.3±100.2 days per patient for the BiVADs group and 74.7±95.9 for TAH group (p=0.8). Fourty two (63%) BiVADs recipients were successfully bridged to transplantation (n=39, 58%) or recovery (n=3, 5%), whereas 47 patients (64%) underwent transplantation in the TAH group. Death while on support was not significantly different between groups (BiVADs group: n=26, 39% vs TAH group: n=26, 36%). No difference in term of overall survival has been founded between groups. Post-transplant actuarial survival in the BiVADs group was 76.0±7.0%, 69.8±7.7%, and 58.3±8.9% at 1, 3, and 5 years after transplantation, respectively, and was not significantly different from that observed in the TAH group (80.9±5.7%, 76.2±6.3%, and 73.3±6.7%, p=0.36). There were no significant differences in survival while on support and up to 5 years after heart transplantation in patients requiring biventricular support using either BiVADs or the TAH