Thangappan Karthik, Ashfaq Awais, Villa Chet, Morales David L S
Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Ann Cardiothorac Surg. 2020 Mar;9(2):89-97. doi: 10.21037/acs.2020.02.08.
While ventricular assist devices (VADs) remain the cornerstone of mechanical circulatory support (MCS), the total artificial heart (TAH-t) has gained popularity for certain patients in whom VAD support is not ideal. Congenital heart disease (CHD) patients often have barriers to VAD placement due to anatomic and physiological variation and thus can benefit from the TAH-t. The purpose of this study is to analyze the differences in TAH application and outcomes in patients with and without CHD.
The SynCardia Department of Clinical Research provided data upon request for all TAH-t implantations worldwide from December 1985 to October 2019. These patients were divided into two groups by pre-implantation diagnosis of CHD and non-CHD.
A total of 1,876 patients were identified. Eighty (4%) of these patients also carried a diagnosis of CHD. There was a higher proportion of children in the CHD cohort (16.3% 2.1%, P<0.001) and this translated into a lower average age amongst the two groups (34±13 49±13 years, P<0.001). There were also significantly more females in the CHD group (22.8% 12.8%, P=0.010). CHD patients were more likely to be supported with a 50 cc TAH-t (11.3% 4.5%, P=0.005) while all other support characteristics, including duration of support, were similar between the groups. All measured outcomes were similar between CHD and non-CHD patients including positive outcome (alive on device or transplanted), 1-month conditional survival, and rate of Freedom Driver use.
TAH-t is an effective means to support patients with CHD. Patients with CHD had similar survival, support characteristics, and frequency of discharge compared to patients without CHD. As MCS continues to grow, its indications broadened, and its contraindications narrowed, more patient populations will see the benefit of the TAH's continuously developing technology.
虽然心室辅助装置（VAD）仍然是机械循环支持（MCS）的基石，但全人工心脏（TAH-t）在某些VAD支持不理想的患者中越来越受欢迎。先天性心脏病（CHD）患者由于解剖和生理变异，在植入VAD时往往存在障碍，因此可以从TAH-t中获益。本研究的目的是分析患有和未患有CHD的患者在TAH应用和结果方面的差异。
SynCardia临床研究部应要求提供了1985年12月至2019年10月全球所有TAH-t植入患者的数据。这些患者根据植入前CHD和非CHD的诊断分为两组。
共识别出1876例患者。其中80例（4%）患者也被诊断患有CHD。CHD队列中的儿童比例较高（16.3%±2.1%，P<0.001），这导致两组的平均年龄较低（34±13岁对49±13岁，P<0.001）。CHD组中的女性也明显更多（22.8%对12.8%，P=0.010）。CHD患者更有可能使用50 cc的TAH-t进行支持（11.3%对4.5%，P=0.005），而两组之间的所有其他支持特征，包括支持持续时间，均相似。CHD和非CHD患者之间所有测量的结果均相似，包括阳性结果（使用装置存活或移植）、1个月条件生存率和自由驱动使用率。
TAH-t是支持CHD患者的有效手段。与未患有CHD的患者相比，患有CHD的患者在生存、支持特征和出院频率方面相似。随着MCS的不断发展，其适应证扩大，禁忌证缩小，更多患者群体将受益于TAH不断发展的技术。
