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 Table of Contents  
LETTER TO THE EDITOR
Year : 2017  |  Volume : 5  |  Issue : 1  |  Page : 142-143

Artificial heart transplantation


1 Department of Internal Medicine, Orange Park Medical Center, Florida, USA
2 Department of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan

Date of Web Publication16-Jun-2017

Correspondence Address:
Salman Assad
Department of Medicine, Shifa Tameer.e.Millat University, Islamabad
Pakistan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_34_17

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How to cite this article:
Minhas AM, Assad S. Artificial heart transplantation. Arch Med Health Sci 2017;5:142-3

How to cite this URL:
Minhas AM, Assad S. Artificial heart transplantation. Arch Med Health Sci [serial online] 2017 [cited 2019 Aug 19];5:142-3. Available from: http://www.amhsjournal.org/text.asp?2017/5/1/142/208194



Sir,

Heart failure has a fair share in disease burden worldwide. A very large portion with advanced heart failure has a very poor prognosis despite being on optimized medical therapy. Unfortunately, there is a huge mismatch in demand and supply for heart donors and recipients. For the patients awaiting cardiac transplantation, mechanical circulatory support has been widely utilized in the form of left ventricular assist device (LVAD) or total artificial heart (TAH). Both TAH and LVAD have been approved for the use as a bridge to transplantation; however, only LVAD has been approved for use as the destination therapy.[1] Currently, a trial is underway to support the use of TAH as the destination therapy. Most of the patients benefit from LVADs; however, the use of TAH is more appropriate in the patients who have concurrent right heart failure or other structural abnormalities.

Until now, almost 1600 TAHs have been transplanted. SynCardia temporary TAH is currently the only Food and Drug Administration (FDA), and Health Canada approved artificial heart commercially available in the market that is being used in over 50 centers in the world. A trial for Cardio West TAH (now being marketed as SynCardia TAH) was conducted between 1993 and 2002. Eighty-one patients were implanted with the device. At the end of the study, the rate of survival to transplantation was 79%, and 1- and 5-year survival rates after transplantation were 86% and 64%.[2]

SynCardia TAH consists of two artificial ventricles, each made of semirigid polyurethane. Each ventricle consists of two single leaflet mechanical valves, which regulate the blood flow. This pulsatile device is capable of generating up to 9.5 L/min of blood flow. Both the ventricles are attached to pneumatic drivelines, which are connected to the back of the external console. The console includes a monitoring computer that provides noninvasive diagnostic information. The device is surgically implanted after the removal of both the ventricles and four valves. It can only be placed in the patients with large enough body habitus that can accommodate its positioning.

A study of 47 patients evaluating the safety of device showed that patients who were supported on SynCardia TAH for more than 1 year had the following complications: systemic infections in 25 patients (53%), driveline infections in 13 patients (27%), thromboembolic events in 9 patients (19%), and hemorrhagic events in 7 patients (14%).[3]

FDA has already approved a clinical study for 19 patients to evaluate the effectiveness of SynCardia as the destination therapy.[4] Smaller SynCardia has also been designed for the use in patients with smaller body habitus and pediatric population. Moreover, the use of portable freedom driver allows the mobility of the patients and safe discharge from the hospital.[5] More clinical trials are needed to evaluate the efficacy of artificial hearts for their utilization in destination therapy. Awareness is needed about these devices in the medical community that would eventually prompt the government agencies to promote research in this area.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Cooley DA. The total artificial heart. Nat Med 2003;9:108-11.  Back to cited text no. 1
    
2.
Copeland JG, Smith RG, Arabia FA, Nolan PE, Sethi GK, Tsau PH, et al. Cardiac replacement with a total artificial heart as a bridge to transplantation. N Engl J Med 2004;351:859-67.  Back to cited text no. 2
    
3.
Torregrossa G, Morshuis M, Varghese R, Hosseinian L, Vida V, Tarzia V, et al. Results with SynCardia total artificial heart beyond 1 year. ASAIO J 2014;60:626-34.  Back to cited text no. 3
    
4.
FDA Approves the SynCardia Total Artificial Heart for Destination Therapy Study. Available from: http://www.syncardia.com/2015-press-releases/fda-approves-the-syncardia-total-artificial-heart-for-destination-therapy-study.html. [Last accessed on 2017 Feb 21].  Back to cited text no. 4
    
5.
Demondion P, Fournel L, Niculescu M, Pavie A, Leprince P. The challenge of home discharge with a total artificial heart: The La Pitie Salpetriere experience. Eur J Cardiothorac Surg 2013;44:843-8.  Back to cited text no. 5
    




 

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