Orthotopic transplantation after implantation of a Jarvik 7 total artificial heart
Cabrol, C.; Solis, E.; Muneretto, C.; Pavie, A.; Gandjbakhch, I.; Bors, V.; Szefner, J.; Leger, P.; Cabrol, A.
Journal of Thoracic and Cardiovascular Surgery 97(3): 342-350
1989
ISSN/ISBN: 0022-5223 PMID: 2645467 Document Number: 332152
A total artificial heart was used to support the circulation in 33 heart transplantation candidates who were expected to die before procurement of a donor heart. Twelve of these patients (mean age 35 .+-. 10 years) underwent cardiac transplantation. Another patient is still being supported with the total artificial heart 90 days after implantation. The other 20 patients died during mechanical support because their condition could not be stabilized for transplantation, despite blood flow restoration. Fifty-six percent of the patients younger than 40 years underwent successful transplantation and six of nine patients are long-term survivors. By comparison, in the older group, 17.6% of patients underwent transplantation and one of three survived long term. Forty-four percent of patients in the acute decompensation group had successful transplantation and four of seven patients are long term survivors. In the chronic decompensation group these figures were 29.4% and three of five patients. All patients who were heavily immunosuppressed (n = 4) died of sepsis. Transplantation was considered and performed only when the patient's condition was correct and stable. In six patients an infection developed in the immediate posttransplant period. Three of the infections were resolved with antibiotic therapy. One originated in the mediastinum and is still unresolved, although the patient's condition is improving. Another patient died of an anoxic coma caused by ventilatory problems. There were two late deaths at 14 and 19 months, one resulting from a combination of toxoplasmosis and rejection and the other from a Kaposi sarcoma caused by azathioprine treatment. In conclusion, selection of the patient before implantation of the total artificial heart is critical to the outcome of the procedure. A strict policy of attempting heart transplantation only in the absence of any usual contraindications should be applied for patients subjected to bridge to transplant procedures. Survival after transplantation performed under such conditions seems to be equal to that of conventional orthotopic transplantation.