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Clinical application and patient selection in the use of a total artificial heart as a bridge for transplantation
E Solis1, P Leger, C Muneretto
1Department of Cardiovascular Surgery, Hospital La Pitié, Paris, France.
Insights
Total artificial heart (Jarvik 7) implantation in 21 patients showed a 47.6% transplant success rate. Early implantation is recommended for younger patients and those with acute myocardial failure to improve outcomes.
Area of Science:
- Cardiology
- Medical Engineering
Background:
- The Jarvik 7 total artificial heart was implanted in 21 patients between 1986 and 1987.
- The study included 18 men and 3 women, with a mean age of 37.3 years.
Purpose of the Study:
- To evaluate the outcomes of orthotopic total artificial heart implantation.
- To identify factors influencing transplant success rates in patients receiving the Jarvik 7.
Main Methods:
- Orthotopic implantation of 70 ml or 100 ml Jarvik 7 total artificial hearts in 21 patients.
- Analysis of variables including patient age, cardiac condition (acute decompensation vs. chronic failure), and etiology.
- Assessment of transplant success, survival during circulatory support, and causes of death.
Main Results:
- Overall transplant success rate was 47.6% (10 patients); 52.4% (11 patients) died during support, primarily from sepsis and multiple organ failure.
- Younger patients (≤40 years) had an 80% transplant success rate compared to 25% in older patients.
- Patients with acute cardiac decompensation had a 75% success rate versus 44.4% for those with chronic illness.
Conclusions:
- Early total artificial heart implantation is recommended for younger patients and those with acute myocardial failure to improve transplant success.
- The device is contraindicated in immunosuppressed patients due to high infection risk.
- No significant thromboembolic complications or heart-chest cavity mismatches were observed.
Abstract:
Between April 1986 and July 1987, 21 patients underwent orthotopic implantation of a total artificial heart (Jarvik 7) at La Pitié Hospital. There were 18 men and 3 women with a mean age of 37.3 +/- 11.4 years. The device implanted was the 70 ml version in 10 patients and the 100 ml version in 11 patients. In the results, three variables were analysed: age, acute myocardial decompensation or chronic myocardial failure, and aetiology of the 21 patients treated. 10 (47.6%) had adequate support and were successfully transplanted. Eleven patients (52.4%) died during circulatory support. The main causes of death were sepsis and multiple organ failure. In only one patient was a mismatch between the heart and chest cavity present. There was no clinical evidence of thromboembolic complications. Patients of 40 years of age and less have an 80% chance of being successfully transplanted in comparison with a 25% success rate in older patients. Patients that developed sudden cardiac decompensation have a 75% success rate for transplantation in comparison with 44.4% success rate in patients with a chronic illness. Early implantation of the device, before the development of irreversible damage in other organs, is recommended in younger patients with acute or chronic disease and in older patients with acute myocardial failure. The use of this device is contraindicated in immunosuppressed patients due to the high risk of infection.