Feasibility of Outpatient Hemodialysis for Patients With Total Artificial Heart: A Case Series

Area of Science:

• Cardiology
• Nephrology
• Artificial Organs

Background:

• Total artificial hearts (TAH) are critical for end-stage heart failure patients awaiting transplantation.
• Acute kidney injury (AKI) is a frequent complication post-TAH implantation.
• Current protocols often exclude TAH candidates requiring dialysis due to long-term outpatient (OP) dialysis challenges.

Purpose of the Study:

• To evaluate the feasibility of outpatient hemodialysis (HD) for patients with TAH and chronic renal dysfunction.
• To assess the long-term outcomes of TAH patients managed with OP HD.

Main Methods:

• Retrospective case series of four patients implanted with a 70cc Syncardia TM TAH for non-ischemic cardiomyopathy (NICM).
• All patients had post-implant chronic renal dysfunction requiring hemodialysis.
• Management involved outpatient hemodialysis coordinated with the implanting surgical program.

Main Results:

• All four patients were successfully maintained on outpatient hemodialysis.
• Two patients received heart transplants (one with a kidney), and two were managed as destination therapy.
• One destination therapy patient remained on OP HD until end-of-life; the other became transplant-eligible after TAH implantation.

Conclusions:

• Outpatient hemodialysis is a viable and effective option for TAH patients with chronic renal dysfunction.
• Successful implementation requires specialized training and robust support from the TAH implanting program.
• This approach can expand TAH candidacy and improve long-term management for select patients.