Predictors of Early and Late Mortality after Heart Transplantation in Patients Bridged with the Total Artificial Heart
Edward J. SaweyJohn T OwensInna TchoukinaRichard H. CookeMohammed QuaderRoshanak MarkleyMelissa C. SmallfieldDaniel TangK. DesaiKrishnasree RaoMaureen FlatteryPatricia A. UberVigneshwar KasirajanKeyur B. Shah
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634 Terminally ill heart failure patients awaiting heart transplantation (HT) who require mechanical circulatory assistance for survival may have right ventricular function that is too poor to permit isolated left ventricular assist device therapy. In our institution, between July 1, 1994 to December 31, 1996 we used the Cardiowest total artificial heart on such patients who eventually received a heart transplant (Group I). We compared these patients to other patients awaiting HT, who were not as ill prior to HT, who were successfully transplanted without need for any other circulatory assist device(Group II). TableConclusions: In patients fortunate enough to received eventual HT, the use of Cardiowest total artificial heart is a very effective bridge to HT, despite the high hospital charges associated with additional surgery and longer hospitalization.
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634 Terminally ill heart failure patients awaiting heart transplantation (HT) who require mechanical circulatory assistance for survival may have right ventricular function that is too poor to permit isolated left ventricular assist device therapy. In our institution, between July 1, 1994 to December 31, 1996 we used the Cardiowest total artificial heart on such patients who eventually received a heart transplant (Group I). We compared these patients to other patients awaiting HT, who were not as ill prior to HT, who were successfully transplanted without need for any other circulatory assist device (Group II). TableConclusions: In patients fortunate enough to received eventual HT, the use of Cardiowest total artificial heart is a very effective bridge to HT, despite the high hospital charges associated with additional surgery and longer hospitalization. *p<0.01
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The total artificial heart (TAH) is a form of mechanical circulatory support in which the patient's native ventricles and valves are explanted and replaced by a pneumatically powered artificial heart. Currently, the TAH is approved for use in end-stage biventricular heart failure as a bridge to heart transplantation. However, with an increasing global burden of cardiovascular disease and congestive heart failure, the number of patients with end-stage heart failure awaiting heart transplantation now far exceeds the number of available hearts. As a result, the use of mechanical circulatory support, including the TAH and left ventricular assist device (LVAD), is growing exponentially. The LVAD is already widely used as destination therapy, and destination therapy for the TAH is under investigation. While most patients requiring mechanical circulatory support are effectively treated with LVADs, there is a subset of patients with concurrent right ventricular failure or major structural barriers to LVAD placement in whom TAH may be more appropriate. The history, indications, surgical implantation, post device management, outcomes, complications, and future direction of the TAH are discussed in this review.
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Abstract: It became necessary to perform a staged procedure by means of total artificial heart followed by cardiac transplantation in a 26‐year‐old, female patient. The Ellipsoidheart, as an artificial heart, fitted excellently in the chest without compromising the surrounding structures. As soon as the patient recovered with the artificial heart, a consecutive transplantation was performed. This first European clinical experience gained confidence and suggests applying more artificial hearts as a bridge towards transplantation.
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An artificial heart is a continuous-flow pump device with a constant output, which usually supports the left ventricle. Over the past five years, survival rates with an artificial heart have increased dramatically, but with an annual mortality of 10% per year compared with 6% for heart transplantation the artificial heart is mainly a 'bridge to transplantation' or an alternative for those patients who are not suitable for heart transplant, 'destination therapy'. It is anticipated that the number and severity of complications will decrease as a result of technological progress. The artificial heart could then become a long-term treatment option providing a good quality of life and thus become equivalent to a heart transplant.
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