Total artificial heart implantation: supportive care preparedness planning framework

Area of Science:

• Cardiology
• Medical Devices
• Palliative Care

Background:

• Total artificial heart (TAH) implantation is a critical intervention for severe biventricular heart failure and ventricular arrhythmias, serving as a bridge to transplantation.
• Approximately 450 TAHs were implanted between 2006 and 2018, highlighting its use in critically ill patients.
• Prognostic uncertainty in TAH candidates necessitates comprehensive preparedness planning for patients and caregivers.

Purpose of the Study:

• To outline an approach for preparedness planning for patients receiving a total artificial heart.
• To underscore the essential role of palliative care in TAH patient management.

Main Methods:

• A review of current needs and strategies for TAH preparedness planning was conducted.
• Findings were categorized to develop a guide for optimizing conversations with patients and their designated decision-makers.

Main Results:

• Four critical areas for preparedness planning were identified: decision-maker identification, defining minimal acceptable outcomes and maximal acceptable burden, and planning for life with and death with the device.
• A framework utilizing mental/physical outcomes and care locations can help delineate acceptable outcomes and burdens.

Conclusions:

• TAH decision-making is complex, often urgent, and patients may lack decision-making capacity.
• Identifying legal decision-makers and robust social support systems is paramount.
• Involving surrogate decision-makers in preparedness planning, including end-of-life care and treatment cessation, is vital.
• Integrating palliative care specialists into mechanical circulatory support teams facilitates crucial preparedness discussions.