Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany -
J Cardiovasc Surg (Torino). 2023 Feb;64(1):121-129. doi: 10.23736/S0021-9509.22.12445-6.
Total artificial heart (TAH) implantation is a rarely performed procedure. Contrarily, left ventricular assist device (VAD) implantation is rather common in many centers. As transplantation is quantitatively limited cardiac replacement with artificial hearts is a viable alternative in the treatment of severe biventricular heart failure. An alternative to TAH is the implantation of two VADs in a TAH configuration. We hereby present the first multi-center study on 3-months outcomes of patients treated by cardiectomy and placement of two HeartMate 3s in a TAH configuration.
We retrospectively investigated a cohort of 15 patients that underwent HM3-TAH-implantation at three international institutions. Follow-up was 3 months after implantation. Baseline, intra- and postoperative parameters as well as survival data and adverse events were collected.
A total of 1089 days on HM3-TAH were observed. Thirty-day survival after HM3-TAH implantation was 53% (8/15) and three month survival was 40% (6/15). The longest duration on device was 274 days. Causes of death were multi-organ failure, sepsis, and neurological adverse events. No technical complications were documented. Two patients remained on the device. Four patients (26%) were successfully bridged to transplantation.
The implantation of two HeartMate 3s in a TAH configuration is a last resort and off-label concept in cases of extreme biventricular heart failure. In a diligently selected patient cohort, HM3-TAH implantation is a feasible method to increase the chance of survival in a severely ill patient cohort and successfully bridge patients to heart transplantation that would otherwise have died.
全人工心脏（TAH）植入术是一种很少进行的手术。相比之下，左心室辅助装置（VAD）植入术在许多中心较为常见。由于心脏移植的数量有限，人工心脏替代是治疗严重双心室心力衰竭的一种可行选择。TAH 的一种替代方法是在 TAH 构型中植入两个 VAD。在此，我们报告了首例在三个中心进行的心切除术和放置两个 HeartMate 3 型 VAD 的 TAH 构型的 3 个月患者结局的多中心研究。
我们回顾性调查了三个国际中心的 15 名接受 HM3-TAH 植入术的患者队列。随访时间为植入后 3 个月。收集了基线、围手术期参数以及生存数据和不良事件。
共观察到 1089 天的 HM3-TAH。HM3-TAH 植入术后 30 天生存率为 53%（8/15），3 个月生存率为 40%（6/15）。设备最长使用时间为 274 天。死亡原因是多器官衰竭、败血症和神经不良事件。未记录到技术并发症。两名患者仍在使用设备。4 名患者（26%）成功桥接到移植。
在极端双心室心力衰竭的情况下，将两个 HeartMate 3 型 VAD 植入 TAH 构型是最后的手段和超适应证概念。在经过精心选择的患者队列中，HM3-TAH 植入术是一种可行的方法，可以增加严重疾病患者队列的生存机会，并成功桥接患者进行心脏移植，否则这些患者将死亡。
