Permanent dialysis access in a patient with a total artificial heart

Commentary: Permanent dialysis access following total artificial heart implantation: A question of maturity

“… 6 While the lack of pulsatility was theorized to lead to uncertainty of fistula maturation in the setting of continuous flow support, several authors have reported long-term success in this setting with excellent AVF maturation for use in dialysis. 8 , 9 , 10 Now, Hair and colleagues 7 also confirm that AVF can be successfully matured in a circulation supported by a TAH with mechanically induced pulsatile flow. It is, however, important to note that the shunt created by a mature AVF may reach 600 to 1200 mL/min, 4 and the risk of elevating pulmonary vascular resistance should be factored into the decision to pursue an AVF in a bridge-to-transplant candidate.…”

“…Peritoneal dialysis is also a suboptimal option given the proximity of the dialysis catheter to device drivelines and there is also a significant risk of sepsis often in the form of peritonitis. 6 As Hair and colleagues 7 pointed out, transitioning the temporary access to an arteriovenous fistula (AVF) with avoidance of foreign material is currently the most favorable option when recovery of renal function is not anticipated. 6 Readiness for AVF use is determined by its maturation and requires adequate hemodynamics.…”

Commentary: An arteriovenous bridge over novel, troubled water

“… 8 The authors pursued the creation of a staged brachiobasilic arteriovenous fistula in a patient supported with a total artificial heart (TAH). 9 This approach appears plausible for a number of reasons. The Syncardia TAH (SynCardia Systems, Inc, Tucson, Ariz), the only TAH approved by the Food and Drug Administration in the United States, 10 is a pneumatically driven pulsatile flow device, which mitigated the concern for lack of AVF maturation.…”