Initial United Kingdom experience with the syncardia total artificial heart

Abstract

Introduction The SynCardia Total Artificial Heart (TAH) is a form of mechanical circulatory support where the patient's native ventricles and valves are explanted and replaced by a pneumatically powered artificial heart (1). Implantation is indicated in patients with irreversible biventricular cardiac failure (2). We have recently initiated a TAH program at Harefield Hospital for the UK patient population. The aim of this study is to review our initial experience in terms of success rate of bridging patients to transplantation and post cardiac transplant outcomes. Methods We analysed data from all patients who received a TAH from July 2014 until April 2019 at our institution to quantify the rate of successful bridging to transplantation and the subsequent post cardiac transplant outcomes. Results 22patients (males, n = 14; mean age 39 ± 17) received TAH implants due to severe, irrecoverable biventricular failure. Aetiologies were dilated (n = 11, 50%), ischaemic (n = 6, 27%) and valvular (n = 3, 13%) cardiomyopathies. 12 patients (55%) were on veno-arterial extra corporeal membrane oxygen support with mean duration of 8.3 ± 8.6 days prior to TAH implantation. Mean duration on TAH support was 95 ± 114 days. 7 patients (32%) suffered stroke, 8 (36%) required surgical exploration for bleeding and 7 (32%) developed sepsis. 9 patients (40%) were successfully bridged to and received a heart transplant, another 3 patients are on the waiting list. 6 patients (27%) are still living: 3 post heart transplantation and 3 remain on the waiting list for a heart transplant. Discussion We have successfully introduced The TAH program in the UK as an important and unique intervention for a high risk patient population with biventricular heart failure who are not candidates for left ventricular assist device. Despite high rate of perioperative and early mortality and postoperative complications TAH implantation provides a realistic alternative for these otherwise futile cases.