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Updated: May 9, 2026
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Total artificial heart in the pediatric patient with biventricular heart failure
S S Park1, D B Sanders, B P Smith
11Division of Cardiothoracic Surgery, Division of Cardiology, Division of Critical Care Medicine, Children's Heart Center, Division of Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA.
Insights
This case report details the successful use of a Total Artificial Heart (TAH-t) in a pediatric patient with severe heart failure, despite a smaller body surface area than recommended. Advanced imaging techniques ensured proper device fit and management of post-operative complications.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Biomedical Engineering
Background:
- Mechanical circulatory support (MCS) is vital for pediatric end-stage heart failure, primarily as a bridge to cardiac transplantation.
- The Total Artificial Heart (TAH-t) is FDA-approved for biventricular failure but has limited pediatric use due to device size and BSA recommendations.
- This report highlights the first pediatric TAH-t implantation at a specific institution, challenging existing BSA guidelines.
Observation:
- A 14-year-old male with dilated cardiomyopathy and severe biventricular failure required extracorporeal life support.
- The patient presented with diffuse clot formation, necessitating a transition to biventricular assist.
- Despite a BSA of 1.5 m², below the recommended 1.7 m², the TAH-t was implanted.
Findings:
- Computed tomography (CT) and novel 3D modeling were crucial for assessing device fit in a smaller pediatric patient.
- Post-implantation imaging confirmed unobstructed vascular structures and patent bronchi, with no pulmonary vein compression.
- The patient experienced left lung atelectasis, successfully managed with recruitment maneuvers, and was bridged to transplantation in 11 days.
Implications:
- This case demonstrates the feasibility of TAH-t implantation in pediatric patients with BSA below recommended thresholds.
- Advanced imaging, including 3D modeling, is essential for optimizing device selection and managing peri-operative care in pediatric MCS.
- Expanding TAH-t indications in pediatrics may improve outcomes for children with end-stage biventricular failure awaiting transplantation.
Abstract:
Mechanical circulatory support emerged for the pediatric population in the late 1980s as a bridge to cardiac transplantation. The Total Artificial Heart (TAH-t) (SynCardia Systems Inc., Tuscon, AZ) has been approved for compassionate use by the Food and Drug Administration for patients with end-stage biventricular heart failure as a bridge to heart transplantation since 1985 and has had FDA approval since 2004. However, of the 1,061 patients placed on the TAH-t, only 21 (2%) were under the age 18. SynCardia Systems, Inc. recommends a minimum patient body surface area (BSA) of 1.7 m(2), thus, limiting pediatric application of this device. This unique case report shares this pediatric institution's first experience with the TAH-t. A 14-year-old male was admitted with dilated cardiomyopathy and severe biventricular heart failure. The patient rapidly decompensated, requiring extracorporeal life support. An echocardiogram revealed severe biventricular dysfunction and diffuse clot formation in the left ventricle and outflow tract. The decision was made to transition to biventricular assist device. The biventricular failure and clot formation helped guide the team to the TAH-t, in spite of a BSA (1.5 m(2)) below the recommendation of 1.7 m(2). A computed tomography (CT) scan of the thorax, in conjunction with a novel three-dimensional (3D) modeling system and team, assisted in determining appropriate fit. Chest CT and 3D modeling following implantation were utilized to determine all major vascular structures were unobstructed and the bronchi were open. The virtual 3D model confirmed appropriate device fit with no evidence of compression to the left pulmonary veins. The postoperative course was complicated by a left lung opacification. The left lung anomalies proved to be atelectasis and improved with aggressive recruitment maneuvers. The patient was supported for 11 days prior to transplantation. Chest CT and 3D modeling were crucial in assessing whether the device would fit, as well as postoperative complications in this smaller pediatric patient.
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