The Total Artificial Heart

Permanent dialysis access in a patient with a total artificial heart

“…3 In contrast, the Food and Drug Administration-approved TAH produces pulsatile flow through a pneumatic driver to mitigate this challenge. 2,4 In the case of our patient, after discussion regarding the various options for permanent access and the prompt need to remove the TDC, the vascular surgery team agreed that the technical aspects of fistula creation would not differ significantly (Video 1). It was acknowledged, however, that there was an inherent degree of uncertainty.…”

“…Following left ventricular assist device (LVAD) or TAH placement, AKI and the requirement of hemodialysis is a marker of poor prognosis. 1 , 2 Studies suggest that the incidence of AKI following continuous-flow LVAD implantation lies between 7% and 45% whereas the incidence following TAH implantation is potentially even greater, between 19% and 64%. 3 , 4 This is unsurprising, granted the hemodynamic instability and comorbidities characteristic of this population.…”

Commentary: To remove (a heart), or not to remove, that is the question

“…Allowing a TAH to fill only partially may allow some capacity to accommodate abrupt increases in device preload. 2 This can represent a double-edged sword, because accommodating variations in preload must be balanced against decreased stroke volume and cardiac output. Nevertheless, without proper reservoir capacity, excessively increased preload will result in direct transmission of higher pressures to the systemic and pulmonary venous systems.…”