Total artificial heart as a bridge to retransplantation in acute cardiac rejection

Previous clinical experience in the use of a total artificial heart as a bridge to retransplantation in patients with acute major unresponsive cardiac rejection has shown an extremely high risk at various stages of the sequence. Unsatisfactory recovery during the period with the total artificial heart, surgical complications at retransplantation, and infection and/or rejection account for the lack of long-term survivors. A recent case permits the description of an original technique of implantation, which facilitates both the adequate positioning of the prosthetic ventricles and the surgery at retransplantation. The risks of rejection and infectious complications are discussed.