The Burden of Total Artificial Heart Patients and Complications after Heart Transplantation

Purpose Increased perioperative risk has been observed in patients with left ventricular assist devices (LVAD) and total artificial hearts (TAH) undergoing heart transplantation with worse outcomes in TAH patients. The purpose of this study was to review perioperative transplant outcomes in TAH vs LVAD patients at a high-volume transplant center. Methods We reviewed perioperative transplant outcomes of 46 TAH patients and 85 LVAD patients from 2010-2018. Outcomes included perioperative transfusions (units of packed red blood cells, fresh frozen plasma, platelets, cryoprecipitate), time in the operating room (OR), intensive care unit (ICU) days immediately post-transplant, freedom from return to OR for bleeding, freedom from primary graft dysfunction (PGD), and 1-year freedom from temporary dialysis. In addition, 1-year outcomes included survival, freedom from cardiac allograft vasculopathy (CAV), freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, heart failure, percutaneous intervention, defibrillator/pacemaker implant, stroke), and freedom from first-year rejection (any treated rejection (ATR), acute cellular rejection (ACR), antibody-mediated rejection (AMR)). Results TAH patients had more perioperative blood transfusions, and had decreased freedom from return to the OR for bleeding, temporary dialysis, and NF-MACE. There were no differences between groups in the time in OR, ICU days post-transplant, and freedom from PGD, survival, CAV, and rejection. Conclusion TAH patients appear to have increased perioperative post-transplant risk for some parameters though no difference in PGD or survival compared to LVAD patients. In a high volume center, there can be acceptable post-transplant outcomes in TAH patients.