International experience with the CardioWest total artificial heart as a bridge to heart transplantation

Abstract

As the number of potential heart donors remains constant and the number of potential recipients continuous to increase, the need for circulatory devices to bridge patients becomes more important. The CardioWest total artificial heart (TAH) is a pneumatic, implantable system that totally replaces the failing ventricles. It has been utilized worldwide as a bridge to heart transplantation in 79 patients. There were 73 males and six females who received the TAH. Currently three patients remain on the device waiting for transplantation. A total of 55 patients (70%) were transplanted of which 50 survived (91% of patients transplanted) and were discharged home. Idiopathic/dilated cardiomyopathy was the most common etiology followed by ischemic cardiomyopathy. The mean duration of implant was 34 days (range 0-186 days) and the mean age of the group was 45 years (range 16-62 years). Twenty-one patients died while on the device. Multiple organ failure was the major cause of death. There were a total of 255 complications in this group that included reoperation, bleeding, hepatic failure, renal failure, respiratory failure, neurologic events, thromboembolic events, infections, device malfunction, and fit complications. This represented a mean complication rate of three events per patient. The survival rate for the CardioWest TAH of 91% of the patients who reached transplantation is an improvement over that of the Symbion registry (55% of those transplanted) probably as a result of a better patient selection and better control of the coagulation system. These results are also comparable to those survival results obtained with other biventricular and left ventricular assist devices currently available.

Interagency registry for mechanically assisted circulatory support report on the total artificial heart

“…Several publications during the last few decades have shown a wide range of outcomes in patients undergoing TAH implantation. [22][23][24][25][26][27][28][29][30][31][32] This analysis of initial data from the INTERMACS database represents a comprehensive multiinstitutional investigation of the TAH-t experience, providing outcomes, risk factors for death, and AE rates to establish benchmarks. Future analyses of the INTERMACS database will provide in-depth understanding of patients' renal function before and after implantation, rates of hemolysis and neurologic events, quality of life, hospitalization and functional capacity, and their care after hospitalization.…”

Template for preparation of papers for IEEE sponsored conferences & Symposia

“…Implantation of bi-ventricular assist device (BiVAD) and total artificial heart (TAH) are expected to Manuscript It is desired to develop BiVAD and TAH which have small size, an ability to totally assist ventricular function and longer durability. Externally actuated TAHs that comprise two volume-displacement, pneumatically actuated pumps have been used for bridge to transplantations [3,4]. However internally actuated TAHs [5] need hydraulic or mechanical actuators and compliance cambers therefore they are bulky and have limited durability.…”

Anatomic Fitting of Total Artificial Hearts for In Vivo Evaluation

“…However, this is not always sufficient for the large first-generation devices, which are recommended only for patients with a body surface area (BSA) over 1.7 m 2 (3,8,9). However, this is not always sufficient for the large first-generation devices, which are recommended only for patients with a body surface area (BSA) over 1.7 m 2 (3,8,9).…”

“…Unlike the implantation of a VAD, currently available TAHs require removal of the ventricles, which creates space for device placement. However, this is not always sufficient for the large first-generation devices, which are recommended only for patients with a body surface area (BSA) over 1.7 m 2 (3,8,9). Although a large study of patients who received a coronary artery bypass graft reported that only 10% of adults were below this critical BSA (10), a large proportion of children are ineligible for TAH therapy.…”