In end-stage biventricular heart failure, heart transplantation remains the gold standard, but graft shortage and temporary contraindications may preclude access. Among patients who are ineligible for a total artificial heart (TAH), biventricular implantation of continuous-flow left ventricular assist devices (LVADs) has been reported as an off-label salvage strategy in highly selected patients.

From 2023 to 2025, we included consecutive patients who underwent – as a bridge to transplantation – simultaneous biventricular HeartMate 3 implantation at Rennes University Hospital. All had refractory biventricular heart failure and met strict eligibility criteria. We used a previously published surgical approach, with right-sided implantation through an atrial inflow.

This retrospective single-centre analysis included 10 patients who underwent simultaneous biventricular HeartMate 3 implantation. The procedure proved technically feasible. Early mortality occurred in 30% of patients, while the remaining patients achieved initial haemodynamic stabilization under biventricular support. A successful bridge to transplantation was achieved in 30%, after a median (interquartile range) support duration of 223 (153–256) days. Major complications included reoperation for bleeding in 20%, significant infection in 30% but no ischaemic strokes. At discharge, end-organ function was preserved, with median creatinine of 61 μmol/L and median bilirubin of 10 μmol/L.

The so-called HeartMate 6 procedure may represent a feasible salvage bride-to-transplant option in highly selected patients when TAH is unavailable or anatomically unsuitable. Careful selection of patients and a highly trained surgical team is mandatory.