Dong Nian-Guo, D'Alessandro David, Karimov Jamshid, Wang I-Wen, Chen Liang-Wan, Xiao Ying-Bin, Wang Chun-Sheng, Zhao Qiang, Shi Jia-Wei, Yu Shun-Zhou, Zhou Cheng, Leprince Pascal, Ono Minoru, Schmitto Jan, Gong Ming, Shao Yong-Feng, Wang Xian-Qiang, Hao Xing, Hou Xiao-Tong, Li Xin, Wang Wei, Wu Ting, Zhang Hai-Tao, Zhou Cheng-Bin, Li Ping, Wang Yin, Wang Yi-Xuan, Zhang Jing
Department of Cardiovascular Surgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Division of Cardiac Surgery, Massachusetts General Hospital, Boston, 02114, USA.
Curr Med Sci. 2025 Jul 11. doi: 10.1007/s11596-025-00087-3.
While biventricular assist devices (BiVADs) remain underutilized in Western countries for biventricular heart failure (BHF), their application is expanding in China. This consensus synthesizes international guidelines, medical evidence, and Chinese clinical expertise to establish standardized protocols for BiVAD management. Key recommendations include: (1) Preoperative right heart catheterization and echocardiography for central venous pressure (CVP): pulmonary capillary wedge pressure (PCWP) ratio and pulmonary artery pulsatility index (PAPi) assessment (Class I); (2) BiVAD indication in refractory BHF or high-risk right heart failure post-left ventricular assist device (LVAD) implantation (Class IIa); (3) Right atrial implantation as the preferred surgical approach (Class IIa); (4) Warfarin-based anticoagulation (INR 2.0-2.5) with aspirin, avoiding direct oral anticoagulants (DOACs) (Class III). The guidance addresses critical gaps in patient selection, pump speed titration, and complication management, positioning integrated BiVAD systems as a promising solution for complex BHF.
虽然双心室辅助装置（BiVADs）在西方国家用于双心室心力衰竭（BHF）的情况仍未得到充分利用，但其在中国的应用正在扩大。本共识综合了国际指南、医学证据和中国临床专业知识，以建立BiVAD管理的标准化方案。主要建议包括：（1）术前进行右心导管检查和超声心动图以评估中心静脉压（CVP）：肺毛细血管楔压（PCWP）比值和肺动脉搏动指数（PAPi）（I类）；（2）难治性BHF或左心室辅助装置（LVAD）植入术后高危右心衰竭时使用BiVAD（IIa类）；（3）首选右心房植入作为手术方法（IIa类）；（4）采用华法林抗凝（国际标准化比值[INR] 2.0 - 2.5）并联合使用阿司匹林，避免使用直接口服抗凝剂（DOACs）（III类）。该指南解决了患者选择、泵速滴定和并发症管理方面的关键差距，将集成式BiVAD系统定位为复杂BHF的一种有前景的解决方案。
