Feasibility Of Outpatient Hemodialysis For Patients With Total Artificial Heart

Abstract

<h3>Introduction</h3> Total artificial hearts (TAH) are used in patients with end-stage heart failure as a bridge-to-transplant. AKI is a common post-operative complication associated with TAH implant. Patients requiring temporary dialysis are denied implantation of TAH due to the inability to provide outpatient (OP) dialysis in the long term. In most cases, patients with a TAH with renal dysfunction requiring dialysis remain hospitalized until either a heart-kidney becomes available for transplant or renal function recovers. To our knowledge, there is only one case describing a TAH patient successfully maintained on OP dialysis, and he did not survive to transplant. Here we discuss four cases from a single center who were successfully maintained on OP hemodialysis (HD) after implantation of TAH. <h3>Case Presentation</h3> All four patients were implanted with a 70cc Syncardia TAH for NICM. Two were INTERMACS profile 2 and two were profile 3. The profile 2 patients had preoperative CKD Stage III. The profile 3 patients had normal preoperative renal function<b>.</b> Age at time of implant ranged from 31-61 years; two were female and 2 were male. Average post-op hospital length of stay was 63 days. Three patients required discharge to acute rehab, and one was discharged directly home. All patients were on scheduled OP HD QMWF. The average length of service of OP HD was 185 days (ranging 75-483 days). Outcomes for each patient differed: one remains on OP HD with TAH, one died before transplant due to anoxic brain injury, one underwent orthotopic heart transplantation but did not survive to renal transplant, and one had subsequent improvement in renal function still awaiting heart transplant. <h3>Discussion</h3> Maintaining TAH patients with renal failure on OP HD can increase patient quality of life and decrease inpatient hospital burden and costs. In these four cases, one patient survived to transplant, one did not survive to transplant, one is still awaiting dual-organ transplant, and one was successfully weaned off HD as an OP. A total of 318 days of OP HD was performed among these four patients without complications. These cases confirm that OP HD is a feasible option for TAH patients with post-implant chronic renal dysfunction provided that the dialysis centers are trained and supported by the implanting program.