Department of Thoracic and Cardiovascular Surgery, Nantes Hospital University, Nantes, France.
Department of Cardiac Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK.
Eur J Cardiothorac Surg. 2020 Dec 1;58(6):1175-1181. doi: 10.1093/ejcts/ezaa261.
At our centre, the SynCardia temporary Total Artificial Heart (TAH-t) (SynCardia Systems, LLC, Tucson, AZ, USA) is used to provide long-term support for patients with biventricular failure as a bridge to a transplant. However, a heart transplant (HT) after such support remains challenging. The aim of this retrospective study was to assess the immediate and long-term results following an HT in the cohort of patients who had a TAH-t implant.
A total of 73 patients were implanted with the TAH-t between 1988 and 2019 in our centre. Of these 73 consecutive patients, 50 (68%) received an HT and are included in this retrospective analysis of prospectively collected data.
In the selected cohort, in-hospital mortality after an HT was 10% (n = 5). The median intensive care unit stay was 33 days (range 5-278). The median hospital stay was 41 days (range 28-650). A partial or total pericardiectomy was performed during the HT procedure in 21 patients (42%) due to a severe pericardial reaction. Long-term survival rates after an HT at 5, 10 and 12 years were 79.1 ± 5.9% (n = 32), 76.5 ± 6.3% (n = 22) and 72.4 ± 7.1% (n = 12), respectively, which was similar to the long-term survival for a primary HT without TAH-t during the same period (n = 686). An HT performed within 3-6 months post-TAH-t implantation appeared to provide the best survival (P = 0.007). Eight (16%) patients required chronic dialysis during the subsequent follow-up period, with 3 patients requiring a kidney transplant.
The long-term outcomes with the SynCardia TAH-t as a bridge to transplant in patients with severe biventricular failure are very encouraging. Our review noted that an HT following TAH-t can be technically challenging, especially in the case of a severe pericardial reaction, with potential pitfalls that should be recognized preoperatively.
在我们中心，SynCardia 临时全人工心脏（TAH-t）（SynCardia Systems，LLC，Tucson，AZ，USA）用于为双心室衰竭患者提供长期支持，作为移植的桥梁。然而，在此支持后进行心脏移植（HT）仍然具有挑战性。本回顾性研究的目的是评估在我们中心植入 TAH-t 的患者队列中进行 HT 后的即刻和长期结果。
在我们中心，1988 年至 2019 年间共有 73 例患者植入 TAH-t。在这 73 例连续患者中，有 50 例（68%）接受了 HT，并纳入本前瞻性收集数据的回顾性分析。
在选定的队列中，HT 后的院内死亡率为 10%（n=5）。重症监护病房中位停留时间为 33 天（范围 5-278）。中位住院时间为 41 天（范围 28-650）。由于严重的心包反应，在 21 例患者（42%）的 HT 手术中进行了部分或全部心包切除术。HT 后 5、10 和 12 年的长期生存率分别为 79.1±5.9%（n=32）、76.5±6.3%（n=22）和 72.4±7.1%（n=12），与同期无 TAH-t 的原发性 HT 的长期生存率相似（n=686）。在 TAH-t 植入后 3-6 个月内进行 HT 似乎提供了最佳的生存（P=0.007）。在随后的随访期间，有 8 例（16%）患者需要慢性透析，其中 3 例需要肾移植。
在严重双心室衰竭患者中，SynCardia TAH-t 作为移植桥接的长期结果非常令人鼓舞。我们的回顾注意到，TAH-t 后的 HT 在技术上具有挑战性，特别是在心包反应严重的情况下，术前应认识到潜在的陷阱。
