Abstract 17018: Left Ventricular Assist Device Failure With Total Artificial Heart Bridge to Heart Transplant

Abstract

Mechanical support devices are used in cardiogenic shock as a bridge to heart transplantation (OHT) or as a destination treatment. The two long term variants are left ventricular assist devices (LVADs) and total artificial hearts (TAHs). Developed in tandem, LVADs have gained favor, but are not without limitations. Adverse events include thrombosis, bleeding, mechanical failures, ventricular arrhythmias (VAs), and right ventricular failure (RVF). When LVADs fail, often the only options becomes OHT or TAH implantation. This case series retrospectively follows ten patients requiring TAH implantation due to LVAD failure between 12/2009-09/2018 at VCU Health. On admission, all were in multiorgan failure with four requiring hemodialysis and two requiring intubation. Eight patients required extra support including pressors, inotropes, and additional mechanical support. The causes of failure included refractory infection, outflow graft mechanical compromise, right ventricular failure, VAs, and pump thrombosis. The mean time from admission to TAH was 13.5 days. Major adverse events included mediastinal hematoma with tamponade in three patients requiring surgical intervention and one patient with an acute cerebral vascular attack who died. One patient died from ongoing respiratory failure. Another patient died from multiorgan failure and hemorrhage. Of the seven surviving patients, all underwent successful OHT and were alive at one year follow-up. The patients who experience LVAD failure are extremely sick and have limited options. TAH implantation, while not without risk, can be a useful tool to bridge patients to transplant with favorable outcomes.