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Total artificial hearts: bridge to transplantation
Jack G Copeland1, Francisco A Arabia, Pei H Tsau
1Division of Cardiothoracic Surgery, University of Arizona College of Medicine, P.O. Box 245071, Tucson, AZ 85724-5071, USA. jgc@u.arizona.edu
Cardiology Clinics
|June 7, 2003
Summary
The CardioWest Total Artificial Heart (TAH) offers high device output and survival rates for critically ill heart failure patients. With improved pneumatic technology and a portable driver, it
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Artificial Organs
Background:
- The CardioWest Total Artificial Heart (TAH) was developed alongside other early mechanical circulatory support devices.
- Pneumatic technology has advanced, enabling portable drivers and home discharge for patients, reducing healthcare costs and improving patient tolerance.
- The CardioWest TAH was initially designed as a permanent artificial heart and was the first to be used for destination therapy.
Purpose of the Study:
- To evaluate the long-term outcomes and benefits of the CardioWest Total Artificial Heart (TAH).
- To assess the CardioWest TAH's efficacy in critically ill patients with advanced heart failure and biventricular failure.
- To compare the performance and adverse event rates of the CardioWest TAH with other mechanical circulatory support devices.
Main Methods:
- Review of clinical data from patients implanted with the CardioWest TAH.
- Analysis of device performance, including output, filling pressures, and perfusion.
- Documentation and comparison of adverse events such as stroke, infection, and bleeding.
Main Results:
- The CardioWest TAH demonstrates high device outputs, exceeding other approved or investigational devices due to its design simplicity and optimal inflow pathway.
- Low rates of serious adverse events were observed, including rare strokes (0.04-0.068 events/patient year) and infections (12% incidence, no clinical mediastinitis or device endocarditis).
- Bleeding incidence (25-36%) was comparable to or lower than other devices like HeartMate VE LVAD, Novacor, and Thoratec, with no fatal exsanguination.
Conclusions:
- The CardioWest TAH is a valuable device for bridge to transplantation and is suitable for destination therapy, especially with the advent of portable drivers.
- High survival rates and excellent device reliability and durability have been achieved in critically ill patients.
- Continued advancements in pneumatic technology, miniaturization, and manufacturing techniques suggest potential for cost reduction and expanded patient applicability.