Abstract 16945: Total Artificial Heart Implantation in Patients With Intractable Ventricular Arrhythmias

Abstract

Ventricular arrhythmias (VAs) are pathological rhythms that are often incompatible with life and require decisive intervention. If the rhythm is refractory to treatment or causes hemodynamic compromise, mechanical support devices may be required. Oftentimes, patients with underlying heart failure do very poorly with VAs, requiring a higher level of support than can be achieved by most devices, with the exception of LVADs and TAHs. Mechanistically, a TAH is an orthotopic pneumatic biventricular mechanical support device that requires removal of the native cardiac ventricles and replacement with two artificial ventricles. Due to the nature of the procedure, the ventricular substrate, which causes VAs, is removed and the patient receives biventricular mechanical support. This case series retrospectively follows eight patients requiring implantation of a TAH due to intractable VAs between 06/2008 and 03/2017 at VCU Health. On arrival, all patients were in multiorgan failure and requiring hemodynamic support, including a varied combination of support devices, inotropes, and/or pressors. The median time of admission to implantation was 12.6 days. Major adverse events included cerebral vascular attack (CVA), significant bleeding requiring surgical intervention, and surgical site infection. Three patients had ischemic CVAs, three had significant mediastinal hematoma resulting in tamponade requiring intervention, and two had significant operative site infections requiring antibiotics and surgery. Of the original eight patients, six went on to undergo an orthotopic heart transplant, all were alive at one year follow-up. While adverse events can be serious and should be considered when evaluating for implantation, the use of a TAH can be beneficial in patients with intractable VAs and can be used to successfully stabilize patients who would otherwise perish.