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Implantation of the Syncardia Total Artificial Heart
Published on: July 18, 2014
Survival prediction in staged heart transplantation using Jarvik-7 artificial heart
A T Kawaguchi1, C Cabrol, A Pavie
1Chirurgie Cardiovasculaire, Hôpital de la Pitié, Paris, France.
Insights
Predicting survival for patients receiving the Jarvik-7 artificial heart as a bridge to heart transplantation is crucial. A scoring system based on preoperative factors accurately identifies suitable candidates for successful outcomes.
Area of Science:
- Cardiovascular Surgery
- Medical Devices
- Transplantation Medicine
Background:
- Mechanical circulatory assist devices (e.g., Jarvik-7 artificial heart) are used as a bridge to heart transplantation.
- The use of these devices strains donor availability and medical costs.
- Ensuring safe and effective device utilization is paramount.
Purpose of the Study:
- To develop a predictive model for survival in patients undergoing staged heart transplantation with the Jarvik-7 artificial heart.
- To identify key preoperative factors influencing transplant success.
Main Methods:
- Retrospective review of 58 cases using the Jarvik-7 artificial heart.
- Univariate and multivariate analyses to identify significant preoperative factors.
- Development of a scoring system based on six factors: transplant rejection/postoperative heart failure, recipient height, body surface area, hyperbilirubinemia, weight, and age.
Main Results:
- A scoring system (1-4 points per factor) was developed.
- Patients with a total score < 4 demonstrated high survival rates (93% sensitivity).
- A score of >= 4 indicated lower transplant success and discharge rates (70% specificity).
Conclusions:
- Preoperative factors effectively predict transplantability and survival in staged heart transplantation.
- Patient selection and preoperative condition are critical for successful Jarvik-7 use as a bridge to transplantation.
Background:
Because mechanical circulatory assist as a bridge to heart transplantation places a further strain on current donor shortage as well as on medical cost containment, safe and effective use of the device is essential.
Methods And Results:
To predict survival before undertaking staged heart transplantation with the Jarvik-7 artificial heart, our 58 attempts were reviewed retrospectively. Scores of 1-4 were given for six preoperative factors based on results obtained by univariate and multivariate analyses between survivors and nonsurvivors of staged heart transplantation: transplant rejection (scored 4: S4) or postoperative heart failure (S3) as the indication, recipient height < 175 cm (S3), body surface area < 1.8 m2 (S3), hyperbilirubinemia > 24 microM/l (S2), weight < 60 kg (S2), and age > 40 years (S1). Of 14 survivors, 13 had a total score < 4 (sensitivity, 93%), with an average score of 1.6 in contrast to 5.5 for 44 nonsurvivors (p < 0.001). Among 26 patients scored < 4, 21 had heart transplantation, of whom 13 left the hospital. Of 32 patients scored > or = 4, only four could be discharged after transplantation (specificity, 70%).
Conclusions:
Multiple preoperative factors successfully predicted transplantability and survival in staged heart transplantation. The results underscore the importance of preoperative condition and patient selection to achieve successful and effective use of Jarvik-7 as a bridge to heart transplantation.
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