Current functional status of Symbion total artificial heart recipients after transplantation

This multicenter study examines long-term data from the five most experienced North American centers (> 8 total artificial heart [TAH] implants), investigating the functional status of 37 patients who received a Symbion TAH followed by a heart transplant (TX) with post-TX survival > or = 1 year. Primary indications for TAH use included acute cardiogenic shock in 38% (14/37) of patients and deterioration while on the TX waiting list in 35% (13/37). At the time of this study, 86% (32/37) of patients were alive, 94% of whom were functioning at a New York Heart Association (NYHA) classification of I (75% [24/32]) or II (19% [6/32]). NYHA classification before death was I for all five patients who died 40 +/- 17 (r = 14-58) months after transplant. Of the 32 surviving patients, 47% (15) were working, 16% (5) were retired, 12% (4) chose not to work, and 9% (3) were in school. The remaining 16% (5) were unable to work due to surgical limitations. After TX, significant infections occurred in 81% (26/32) of patients and rejection in 72% (23/32). At 1 year after TX, creatinine was within normal limits (< or = 1.4 mg/100 ml or 65-125 mol/L) for 41% (13/32) of patients, 1-2 times normal for 56% (18/32), and > 2 times normal for 3% (1/32). Although TAH is not required for most patients awaiting TX, the device allows excellent long-term functional status in patients otherwise at risk for death. No long-term problems related to the use of temporary mechanical circulatory support were found.