John V. Conte

Introduction: Left ventricular assist device (LVAD) support is associated with many complications, but relatively few studies have examined the full spectrum of complications beyond infectious and bleeding events. Methods: We conducted a retrospective review of patients receiving either a pulsatile‐flow Heartmate XVE (HM1; Thoratec Corp., Pleasanton, CA, USA) or continuous‐flow Heartmate II (HM2; Thoratec Corp.) LVAD at our institution (June 2000 to March 2012). Frequency and date of onset of nonbleeding, noninfectious complications were examined. Results: One hundred eighty‐two LVADs were implanted, 49 HM1, and 133 HM2. Support duration was longer for HM2s (median 358 vs. 112 days; p = 0.0003). Overall, the most frequent complications were respiratory failure, ventricular arrhythmia, atrial arrhythmia, right heart failure, and renal failure. Respiratory failure, arrhythmias, severe psychiatric events, and renal failure all occurred with median date of onset ≤ seven days postprocedure. Right heart failure, hepatic failure, thromboembolism, and transient ischemic attacks had a median date of onset 8 to 30 days postprocedure. Stroke, hemolysis, and device failure occurred mostly more than a month postoperatively. Right heart failure, hepatic failure, and device failure were more frequent in HM1 patients than in HM2 patients. Several events, including stroke, had much later onset in HM2 patients. Conclusion: In this 10‐year review of complications following LVAD implantation, the most common adverse events tended to occur early after implantation. As pulsatile‐flow HM1s showed greater frequency and earlier onset of some adverse events, our data suggest better overall outcomes with the continuous‐flow HM2s. (J Card Surg 2012;27:630‐638)

End-stage allograft failure following cardiac transplantation is a devastating problem, and retransplantation offers the only chance for survival. We present the case of a young man with a failing cardiac allograft who underwent allograft cardiectomy, atrial pouch formation, and biventricular assist device (BiVAD) placement as a salvage maneuver.