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Published on: July 18, 2014
Total Artificial Heart as Bridge to Heart Transplantation in Chagas Cardiomyopathy: Case Report
A Ruzza1, L S C Czer2, M De Robertis1
1Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA.
Insights
Chagas disease cardiomyopathy can be managed with a total artificial heart (TAH) as a bridge to heart transplantation (HTx). This approach avoids immunosuppression and allows successful transplantation with no disease recurrence.
Area of Science:
- Cardiology
- Infectious Diseases
- Transplantation Immunology
Background:
- Chagas disease (CD) is an emerging cause of dilated cardiomyopathy globally, particularly in non-endemic regions due to migration.
- Heart transplantation (HTx) is a treatment for end-stage CD cardiomyopathy, but immunosuppression poses a risk of parasite reactivation.
- The total artificial heart (TAH) offers mechanical circulatory support, avoiding immunosuppression and mitigating risks before HTx.
Observation:
- A patient with severe biventricular dysfunction due to Chagas disease cardiomyopathy received a TAH for mechanical circulatory support.
- The patient was supported by the TAH for over six months, followed by a successful orthotopic heart transplantation.
- Post-transplantation treatment included three months of benznidazole therapy.
Findings:
- The patient remained alive over 30 months after TAH implantation and 24 months post-HTx.
- Endomyocardial biopsies up to one year after HTx showed no evidence of Chagas disease recurrence in the transplanted heart.
- This case demonstrates the feasibility of TAH as a bridge to HTx in Chagas disease cardiomyopathy.
Implications:
- The use of TAH may be a viable strategy for managing advanced Chagas disease cardiomyopathy, reducing the risk of parasitic reactivation.
- This approach could expand treatment options for patients with Chagas disease and end-stage heart failure awaiting transplantation.
- Long-term outcomes and the role of antiparasitic therapy in conjunction with TAH and HTx warrant further investigation.
Abstract:
Chagas disease (CD) is becoming an increasingly recognized cause of dilated cardiomyopathy outside of Latin America, where it is endemic, due to population shifts and migration. Heart transplantation (HTx) is a therapeutic option for end-stage cardiomyopathy due to CD, but may be considered a relative contraindication due to potential reactivation of the causative organism with immunosuppression therapy. The total artificial heart (TAH) can provide mechanical circulatory support in decompensated patients with severe biventricular dysfunction until the time of HTx, while avoiding immunosuppressive therapy and removing the organ most affected by the causative organism. We report herein a patient with CD and severe biventricular dysfunction, who had mechanical circulatory support with a TAH for more than 6 months, followed by successful orthotopic HTx and treatment with benznidazole for 3 months. The patient had no evidence of recurrent disease in the transplanted heart based on endomyocardial biopsy up to 1 year post-transplantation, and remains alive more than 30 months after insertion of a TAH and 24 months after HTx.
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