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Improved early survival with the total artificial heart
Michel Haddad1, Roy G Masters, Paul J Hendry
1Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Artificial Organs
|February 14, 2004
Summary
Improved total artificial heart (TAH) management, including early rehabilitation and antibody measurement, reduced infection and rejection rates. While hospital survival increased, it was not statistically significant, suggesting management changes positively impacted TAH patient outcomes.
Area of Science:
- Cardiology
- Medical Technology
- Transplantation Surgery
Background:
- The total artificial heart (TAH) is a critical device for patients with end-stage heart failure awaiting transplantation.
- Assessing the evolution of TAH management and its impact on patient outcomes is essential for improving care.
Purpose of the Study:
- To evaluate the effect of updated management strategies on outcomes in patients receiving a TAH as a bridge to transplant.
- To compare outcomes between patients implanted during two distinct eight-year periods with differing management protocols.
Main Methods:
- A retrospective analysis of 31 patients who received a TAH as a bridge to transplant, divided into two groups based on implantation period (Group A: first 8 years, Group B: last 8 years).
- Key management changes included immediate sternal closure, early extubation, delayed transplant listing, early rehabilitation, and preformed antibody measurement.
- Outcomes analyzed included infection rates, rejection episodes, neurological events, need for reoperation, and hospital survival.
Main Results:
- Group B demonstrated lower infection rates during support (31% vs. 39%) and post-transplant (38% vs. 72%) compared to Group A.
- Rejection rates were significantly lower in Group B (0% vs. 44%).
- Hospital survival improved from 61% in Group A to 85% in Group B, though this difference was not statistically significant. Reopening was more frequent in Group B (61% vs. 28%).
Conclusions:
- Changes in patient management protocols, implemented in the latter period, appear to be associated with reduced infection and rejection rates after TAH implantation.
- Despite improvements in survival trends, further investigation is warranted to confirm the statistical significance of enhanced TAH management strategies on long-term patient survival.