Technical aspects of total artificial heart implantation for temporary applications

Temporary use of the Jarvik-7 artificial heart in critically ill patients awaiting transplantation has prevented death in greater than 60% of attempts. Success is very dependent on meticulous surgical technique. Failures in the operating room cascade into enlarging problems postoperatively. Appropriately selected patients implanted without bleeding or fit problems recover quickly and are suitable candidates for transplantation within a few days. Even acute renal failure or pulmonary insufficiency from end-stage cardiac disease rapidly reverses upon restoration of normal hemodynamics. Anticoagulation is mandatory to prevent thromboembolism and continuous heparin plus oral dipyridamole is the most successful regimen to date. Primary intraoperative security of all suture lines or potential bleeding foci is thus essential. Bleeding has been associated with tamponade, pulmonary complications, and transfusion stimulated anti-HLA antibodies which can prevent subsequent transplantation. The length and suturing technique of the aortic conduit are critical. Compression of the mediastinal structures by the device can impede systemic or pulmonary venous return, with disastrous results. Displacement of the blood pumps away from the midline, usually into the pleural space, allows for more room when closing the sternum. The 100 cc blood pump fits best in patients greater than 85 kg, while the 70 cc model can be implanted in patients as small as 50-60 kg.