Staged cardiac transplantation. Total artificial heart or ventricular-assist pump?

Because of donor organ unavailability, staged cardiac transplantation has been performed in eight patients with The Pennsylvania State University pneumatic total artificial heart (two patients) or with the Pierce-Donachy ventricular-assist pump (six patients). Of the six patients who received the ventricular-assist pump, four received cardiac allografts after 3, 11, 21, and 31 days of pump support, respectively. Two patients died before transplantation; the causes of death were non-device-related complications. One additional patient died of Pseudomonas sepsis after staged cardiac transplantation. The remaining three patients are alive and have been followed up for as long as 2 years after staged cardiac transplantation. Of the two patients who were supported with the total artificial heart, one underwent staged cardiac transplantation after 11 days of support. Unfortunately, this patient succumbed to fungal sepsis 17 days later. The remaining patient, who received the total artificial heart after rejection of a transplanted heart, expired 379 days later before a suitable donor organ could be located. These experiences indicate that 1) the ventricular-assist pump and total artificial heart can provide reasonably safe effective circulatory support until a patient's overall physiological status is optimal, until a donor organ can be located for transplantation, or both; 2) there is a need for short-, intermediate-, and long-term support system capabilities; and 3) regardless of the patients' underlying pathology (ischemic versus nonischemic cardiomyopathy), in most instances, the simpler external ventricular-assist pump is capable of satisfactory hemodynamic circulatory assistance.