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Updated: May 11, 2026
Implantation of the Syncardia Total Artificial Heart
Published on: July 18, 2014
Results with an anticoagulation protocol in 99 SynCardia total artificial heart recipients
Jack Copeland1, Hannah Copeland, Paul Nolan
1Department of Surgery, University of California, San Diego, CA, USA. jackcope3@gmail.com
Insights
This study found a low embolic stroke incidence of 0.08 per patient year in total artificial heart (TAH) recipients using a consistent anticoagulation protocol. The recommended protocol effectively managed anticoagulation and minimized stroke risk in TAH patients.
Area of Science:
- Cardiology
- Biomedical Engineering
- Neurosurgery
Background:
- Total artificial heart (TAH) implantation requires careful management of anticoagulation to prevent thromboembolic complications.
- Long-term anticoagulation strategies for TAH recipients are crucial for device longevity and patient outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of a consistent 15-year anticoagulation protocol in SynCardia Systems TAH recipients.
- To determine the incidence of embolic stroke and bleeding complications in TAH patients on this specific protocol.
Main Methods:
- A cohort of 99 consecutive TAH recipients was managed with a standardized anticoagulation protocol.
- Thromboelastography and platelet aggregation studies guided therapy with dipyridamole, pentoxifylline, aspirin, and heparin.
- Monitoring included partial thromboplastin times, international normalized ratios, and platelet counts.
Main Results:
- An embolic stroke incidence of 0.08 per patient year was observed in 97 patients without endo-device infection.
- No spontaneous hemorrhagic strokes occurred; however, two patients with endo-device infections experienced strokes.
- Postimplantation bleeding occurred in 20% of patients, primarily within the first postoperative week, with 4% experiencing gastrointestinal bleeding. Heparin-induced thrombocytopenia was not observed.
Conclusions:
- The consistent anticoagulation protocol resulted in low stroke rates for total artificial heart support.
- The protocol is recommended for managing anticoagulation in TAH recipients, balancing stroke prevention with bleeding risk.
Abstract:
For 15 years, we employed a consistent anticoagulation protocol in 99 consecutive SynCardia Systems total artificial heart (TAH) recipients. Thromboelastography and platelet aggregation studies were used for evaluating and modulating therapy with dipyridamole, pentoxiphylline, aspirin, and heparin. Partial thromboplastin times, international normalized ratios, and platelet counts were also followed. After the second post-implant day in patients who were free of endo-device infection (97 patients), the embolic stroke incidence was 0.08 per patient year. This included 23.6 patient years of device support. There were no spontaneous hemorrhagic strokes. Two patients had endo-device infections and both had strokes. Postimplantation bleeding was seen in 20% of patients. All but two of these were within the first postoperative week. In all, 4% of patients had gastrointestinal bleeding. We did not observe heparin-induced thrombocytopenia in any patient. We conclude that stroke rates on TAH support have been low, and recommend this protocol.
