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PATIENT CASE

A 55-year-old male with a history of dilated ischemic cardiomyopathy, presented with NYHA Class IV CHF, with worsening SOB. Echo demonstrated biventricular failure. Invasive hemodynamic monitoring suggested low cardiac output with elevated filling pressures including a high CVP and laboratory values were indicative of renal and hepatic dysfunction. Initial trial of therapy with dual inotropes did not lead to an improvement in his clinical status. His ABO blood group was O+. He was considered a candidate for advanced therapies and a TAH was inserted. Following adequate clinical recovery and improvement in his functional and nutritional status, he had a heart transplantation and was discharged in a stable condition.

INTRODUCTION

Heart transplantation is considered the gold standard for the treatment of end-stage heart failure (HF). However, the total number of patients receiving heart transplantation worldwide in the last few decades has remained around 4000 due to the limitations posed by the supply of donor hearts. The rising worldwide epidemic of HF coupled with increasing waitlist times for heart transplantation has made the concept of developing heart assist or heart replacement devices a reality. Total artificial heart (TAH), ventricular assist device (VAD), and cardiopulmonary bypass technologies all share the same lineage, originating in 1934 when Michael Ellis DeBakey described a dual roller pump for blood transfusions. This brought about a new era in cardiac surgery and the dawn of mechanical circulatory support. The critical difference between a VAD and TAH is that the native heart is left in situ during a VAD implantation, whereas implantation of the TAH requires excision of the left and right ventricles of the heart and replacing them with the TAH in the orthotropic position. The majority of patients in New York Heart Association (NYHA) class IV HF can be supported with isolated left VAD (LVAD) only—evidenced by the fact that more than 20,000 LVADs have been implanted worldwide. However, a minority of patients present with biventricular failure or other structural abnormalities of the heart precluding the placement of an isolated LVAD only. The TAH is an excellent therapeutic option under those circumstances. The TAH has been implanted in more than 1400 patients in North America, Europe, Russia, Turkey, Israel, and Australia with nearly all the implants being the SynCardia temporary Total Artificial Heart (SynCardia Systems, Inc.; Tucson, AZ, US).

The objective of this chapter is to give a brief review on the evolution and development of the TAH, its indications, clinical management, outcomes, and the current advances.

A BRIEF HISTORY

A clear start in the history of the TAH can be attributed to some of the scientific incentives advocated by the Kennedy administration in the 1960s. The National Institutes of Health initiated an artificial heart program for the development of partial and complete cardiac replacement devices. Parallel efforts progressed in Baylor College of Medicine in Texas, Cleveland Clinic, Pennsylvania State University, ...

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