Outcomes after heart transplantation and total artificial heart implantation: A multicenter study

doi:10.1016/j.healun.2020.11.012

The Journal of Heart and Lung Transplantation

Volume 40, Issue 3, March 2021, Pages 220-228

https://doi.org/10.1016/j.healun.2020.11.012 Get rights and content

BACKGROUND

We sought to assess the outcomes after heart transplantation (HT) of patients supported with a temporary total artificial heart (t-TAH) as a bridge to transplantation in high-volume centers.

METHODS

A retrospective analysis of 217 consecutive patients who underwent t-TAH (SynCardia Systems, Tucson, Arizona) implantation between January 2014 and May 2019 in 6 high-volume North American centers was performed. End points included survival and adverse events after t-TAH and HT.

RESULTS

The mean age of patients was 49 ± 12 years, and heart failure etiologies were non-ischemic dilated cardiomyopathy (36%), ischemic (25%), restrictive (12%), and cardiac graft failure (9%). A total of 101 (48%) patients had Interagency Registry for Mechanically Assisted Circulatory Support patient profile 1, and 65 (31%) had Interagency Registry for Mechanically Assisted Circulatory Support patient profile 2. At the end of the study period, 138 of 217 (63.5%) patients had undergone HT, and 75 (34.5%) patients died before HT. The mean time between t-TAH implantation and HT averaged 181 ± 179 days (range: 0–849) and the mean follow-up after HT was 35 ± 25 months. The overall survival in the entire cohort was 75%, 64%, and 58% at 1, 2, and 5 years, respectively. Post-transplant survival was 88%, 84%, 79%, and 74% at 6 months, 1 year, 2 years, and 5 years, respectively. Among the 32 patients (23%) who died after HT, the main causes of death were chronic allograft vasculopathy (25%), multiorgan failure (21.8%), sepsis (15.6%), and stroke (9%).

CONCLUSION

In this multicenter study, almost two thirds of patients implanted with a t-TAH could be transplanted. The overall and post-transplantation survival after t-TAH was satisfactory in these critically ill patients.

Section snippets

Patient population

A retrospective analysis of 217 consecutive patients who underwent t-TAH (SynCardia Systems Tucson, Arizona) implantation between January 2014 and May 2019 in the following 6 high-volume North American centers was performed: (1) Cedars-Sinai Heart Institute, Los Angeles, CA (n = 93); (2) The Pauley Heart Center, Virginia Commonwealth University, Richmond, VA (n = 48); (3) Mount Sinai Medical Center, New York, NY (n = 27); (4) University of Washington, Seattle, WA (n = 24); (5) Montreal Heart

Patient characteristics before t-TAH implantation

All patients were deemed candidates for HT and underwent t-TAH implantation as a BTT strategy. Patients averaged 49.7 ± 12.8 years old, and 183 (84%) were male (Table 1). Atrial fibrillation (44%) and history of tobacco use (42%) were the most common associated conditions. Eleven patients (5%) were highly allosensitized (panel reactive antibody ≥80%). Etiologies of cardiomyopathy were non-ischemic dilated (36%), ischemic (25%), restrictive (12%), or chronic graft failure (9%). In total, 33% of

Discussion

The following were the main findings of this contemporary analysis of 217 consecutive patients who underwent t-TAH implantation in 6 high-volume North American centers:

1.
Patient survival rates averaged 75% and 61% at 1 and 3 years after t-TAH implantation, respectively, which is higher than previously reported.
2.
Survival after heart transplant was excellent, reaching 84% at 1 year.
3.
Age at t-TAH implantation was the most important predictor of death under t-TAH support and after HT.
4.
Lack of functional

Conclusion

Three fourth of patients who underwent t-TAH implantation were alive 1 year after surgery, even though 79% were IPP 1 or 2. Survival at 1 year after transplantation averaged 84%, an excellent outcome considering that half of the patients were in cardiogenic shock and 25% on veno-arterial ECMO and 9% on percutaneous temporary mechanical support at the time of t-TAH implantation. Transplant outcomes in patients bridged with t-TAH are similar to other patients undergoing HT in identical

Disclosure statement

Dr Moriguchi is on the SynCardia Medical Advisory Board and received travel expenses. Dr Shah is on the Advisory Board (Consulting) of SynCardia. Dr Mahr reports being a consultant/investigator to Abbott, Medtronic, Abiomed, and SynCardia. Dr Skipper is an international trainer (proctor) for SynCardia. The remaining authors have no conflicts of interest to disclose.

Funding was provided by SynCardia Systems, LLC, Tucson, Arizona.

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We sought to compare heart transplant (HTX) outcomes from patients with a total artificial heart (TAH), biventricular assist device (BiVAD), or left ventricular assist device (LVAD) as a bridge to transplant (BTT). Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS)-Scientific Registry of Transplant Recipients (SRTR) created a dataset with TAH or durable mechanical circulatory support (MCS) who reached HTX between 2006 and 2015.
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Outcomes after heart transplantation and total artificial heart implantation: A multicenter study

BACKGROUND

METHODS

RESULTS

CONCLUSION

Section snippets

Patient population

Patient characteristics before t-TAH implantation

Discussion

Conclusion

Disclosure statement

Ann Thorac Surg

J Heart Lung Transplant

Can J Cardiol

J Heart Lung Transplant

J Biomed Inform

J Heart Lung Transplant

J Thorac Cardiovasc Surg

Ann Thorac Surg