The Cardiowest total artificial heart as a bridge to transplantation: current results at La Pitié hospital

Objectives: To analyse experience with the CardioWest total artificial heart (CW TAH) which provides complete circulatory support by replacing both native cardiac ventricles and all cardiac valves. Methods: We performed a retrospective analysis of the demographics, clinical characteristics and survival of patients bridged to transplantation using the CW TAH. Results: From 2000 to 2010, the CW TAH was implanted in 82 consecutive patients (74 males, mean age 47±13 years) suffering cardiogenic shock secondary to idiopathic (n=42, 45%) or ischaemic (n=23, 28%) cardiomyopathy or other causes (n=17, 21%). Seventeen (21%) patients had a history of previous cardiac surgery. Before implantation, seven (9%) patients had cardiac arrest, 27 (33%) were on a ventilator and 20 (24%) were on extracorporeal membrane oxygenation. Pre-implant creatinine values were 149±86 μmol/l and total bilirubin levels were 45±32 μmol/l. Mean duration of support was 88±106 days (7204 patient-days). Thirty-one (38%) patients died while on support after a mean of 66±113 days of support. Actuarial survival while on support was 74±5%, 66±6% and 50±8% at 30, 60 and 180 days after implantation. While on support, eight (10%) patients suffered stroke, 11 (13%) had mediastinitis and 33 (40%) required surgical re-exploration for bleeding, haematoma or infection. Fifty-one (62%) patients were transplanted after 101±100 days of support. Mean follow-up after transplantation was 56±46 months (2882 patient-months). Actuarial survival rates were 82±5%, 78±6%, 75±6% and 66±8% at 1, 3, 5 and 8 years after transplantation. Conclusions: The CW TAH provided acceptable survival to transplantation rates with low incidence of neurological events. Post-transplant survival was similar to that of patients undergoing primary heart transplantation