Total Artificial Heart Technology: Where Are We Now?
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Purpose of Review
The intended goal of this paper is to review current indications, available devices, and future directions of total artificial heart therapies. Throughout the paper, we sought to help clinicians identify appropriate patients who might be considered for total artificial heart therapy, highlighting the most current data regarding outcomes and adverse events.
The INTERMACS report on the total artificial heart has recently been published in the Journal of Heart and Lung Transplantation and represents the largest study to date on available TAH therapies. Notable findings include better outcomes at experienced centers, likely a result of appropriate patient selection, timing, and management of device therapy.
There are multiple new types of total artificial hearts under development. Having learned from prior experience, and with increasing use and standardization of peri- and post-operative management, there is hope of ongoing success in improving care for those with advanced heart disease and biventricular failure with the use of this technology.
KeywordsTAH Artificial heart Biventricular failure Total artificial heart
Compliance with Ethical Standards
Conflict of Interest
Francisco Arabia is a survival trainer for SymCardia and a consultant for Carmat and Bivacor. Robert Cole declares no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 6.Copeland JG, Levinson MM, Smith R, Icenogle TB, Vaughn C, Cheng K, et al. The total artificial heart as a bridge to transplantation. A report of two cases. JAMA. 1986;256(21):2991–5.Google Scholar
- 9.Pelletier B, Spiliopoulos S, Finocchiaro T, Graef F, Kuipers K, Laumen M, et al. System overview of the fully implantable destination therapy--ReinHeart-total artificial heart. Eur J Cardiothorac Surg. 2015;47(1):80–6. https://doi.org/10.1093/ejcts/ezu321.
- 10.Kobayashi M, Horvath DJ, Mielke N, Shiose A, Kuban B, Goodin M, et al. Progress on the design and development of the continuous-flow total artificial heart. Artif Organs. 2012;36(8):705–13. https://doi.org/10.1111/j.1525-1594.2012.01489.x.
- 11.Glynn J, Song H, Hull B, Withers S, Gelow J, Mudd J, et al. The OregonHeart total artificial heart: design and performance on a mock circulatory loop. Artif Organs. 2017;41(10):904–10. https://doi.org/10.1111/aor.12959.
- 12.Abe Y, Isoyama T, Saito I, Inoue Y, Ishii K, Sato M, et al. Animal experiments of the helical flow total artificial heart. Artif Organs. 2015;39(8):670–80. https://doi.org/10.1111/aor.12543.
- 14.Copeland JG, Copeland H, Gustafson M, Mineburg N, Covington D, Smith RG, et al. Experience with more than 100 total artificial heart implants. J Thorac Cardiovasc Surg. 2012;143(3):727–34. https://doi.org/10.1016/j.jtcvs.2011.12.002.
- 17.Latremouille C, Carpentier A, Leprince P, Roussel JC, Cholley B, Boissier E, et al. A bioprosthetic total artificial heart for end-stage heart failure: results from a pilot study. J Heart Lung Transplant. 2018;37(1):33–7. https://doi.org/10.1016/j.healun.2017.09.002.
- 20.Kormos RL, Teuteberg JJ, Pagani FD, Russell SD, John R, Miller LW, et al. Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: incidence, risk factors, and effect on outcomes. J Thorac Cardiovasc Surg. 2010;139(5):1316–24. https://doi.org/10.1016/j.jtcvs.2009.11.020.
- 21.Copeland JG 3rd, Smith RG, Arabia FA, Nolan PE, Mehta VK, MS MC, et al. Comparison of the CardioWest total artificial heart, the novacor left ventricular assist system and the thoratec ventricular assist system in bridge to transplantation. Ann Thorac Surg. 2001;71(3 Suppl):S92–7. discussion S114–5CrossRefGoogle Scholar
- 22.Kirklin JK, Pagani FD, Kormos RL, Stevenson LW, Blume ED, Myers SL, et al. Eighth annual INTERMACS report: special focus on framing the impact of adverse events. J Heart Lung Transplant. 2017;36(10):1080–6. https://doi.org/10.1016/j.healun.2017.07.005.
- 24.• Morine KJ, Kiernan MS, Pham DT, Paruchuri V, Denofrio D, Kapur NK. Pulmonary artery pulsatility index is associated with right ventricular failure after left ventricular assist device surgery. J Card Fail. 2016;22(2):110–6. https://doi.org/10.1016/j.cardfail.2015.10.019. This represents an important paper because it compares various methods of evaluation of RV function which is critical for appropriate TAH patient selection. CrossRefPubMedGoogle Scholar
- 25.•• Arabia FA, Cantor RS, Koehl DA, Kasirajan V, Gregoric I, Moriguchi JD, et al. Interagency registry for mechanically assisted circulatory support report on the total artificial heart. J Heart Lung Transplant. 2018. https://doi.org/10.1016/j.healun.2018.04.004. This is a very important paper because it represents the largest evaluation of TAH therapy to date, with key findings including outcomes and adverse events.
- 26.• Gohar S, Taimeh ZA, Morgan JA, Frazier OH, AA F, Civitello AB, et al. Use of remote pulmonary artery pressure monitoring (CardioMEMS System) in total artificial heart to assess pulmonary hemodynamics for heart transplantation. ASAIO J. 2018;64(4):e75–e7. https://doi.org/10.1097/MAT.0000000000000726. This paper highlights the use of PA pressure monitoring systems prior to TAH implantation, which may be of particular importance in helping manage patients and for monitoring PA pressures for suitability for heart transplantation. CrossRefPubMedGoogle Scholar