Bivad bi-ventricular assist device complications of BIVAD Therapy

Abstract

Background: Heart failure remains a leading global cause of morbidity and mortality, with advanced cases often requiring mechanical circulatory support (MCS). While left ventricular assist devices (LVADs) have become standard in advanced left-sided failure, patients with biventricular dysfunction require more comprehensive support through biventricular assist devices (BiVADs). BiVAD therapy has evolved as a life-saving intervention, primarily serving as a bridge to transplant, destination therapy, or bridge to recovery.

Methodology: This narrative review synthesizes evidence from clinical registries, cohort studies, and recent device innovations to evaluate complications associated with BiVAD therapy. Key focus areas include hemodynamic imbalances, thromboembolic and hemorrhagic events, device-related dysfunction, infectious risks, neurological complications, and multiorgan dysfunction. Preventive strategies, monitoring protocols, and advances in device design are also discussed.

Results: BiVAD therapy significantly improves survival and quality of life in patients with refractory biventricular failure, but is associated with substantial risks. Hemodynamic imbalance, suction events, device thrombosis, hemolysis, thromboembolism, gastrointestinal and intracranial bleeding, driveline and pocket infections, renal and respiratory dysfunction, and neurological complications remain major concerns. Registry data highlight survival rates approaching those of LVAD recipients with ongoing improvements in outcomes due to advances in device technology, perioperative care, and individualized anticoagulation management. Emerging strategies—such as magnetically levitated pumps, improved cannulation techniques, biofilm-resistant coatings, telemonitoring, and AI-based predictive systems—offer promise in reducing complication rates.

Conclusion: BiVAD therapy is a vital option for patients with advanced biventricular heart failure, but its clinical utility is limited by complex complications that require vigilant multidisciplinary care. Standardized anticoagulation, infection prevention, patient education, and structured follow-up programs are central to improving outcomes. Future directions emphasize fully implantable systems, AI-enabled monitoring, and hybrid artificial heart technologies to enhance safety, reduce infection risks, and extend therapeutic possibilities. Continued collaboration between clinicians, engineers, and researchers will be key to overcoming challenges and advancing the role of BiVADs in modern cardiac care.