Effect of a total artificial heart on adaptive hormonal responses in humans with end-stage heart failure

The J-7 total artificial heart (TAH) can restore normal vascular hemodynamics in humans treated for end-stage heart failure, but less is known regarding its effect on hormones elevated under these conditions. A 49-year-old man with NYHA Class IV end-stage heart failure received a J-7-70 TAH as a bridge to transplantation. Pre-TAH cardiac index was less than 2 L/min/m2 with end organ dysfunction, increased venous and pulmonary pressures, and a low arterial pressure. The TAH provided an immediate cardiac index greater than 3 L/min/m2 with normal hemodynamics and organ function. Pre-TAH renin, aldosterone, and atrial natriuretic factor (ANF) levels were markedly elevated: 147 ng/dl, 29.4 ng/dl, and 380 pg/ml, respectively. All values declined dramatically by the fifth postoperative day, with the aldosterone and ANF values returning to normal at 11.5 ng/dl and 37 pg/ml, respectively. Renin levels reached normal values by the fourth postoperative week. Once normal values were obtained, they remained in this range for the 57 days of TAH function. The TAH, used in end-stage heart failure, restores normal hemodynamics and compensatory hormonal levels. These hormones can be used as indicators of proper TAH function in such patients.