Total Artificial Heart versus Bi-Ventricular Assist Device: Meta-Analysis of Long-Term Survival and Systematic Review

Abstract

<h3>Purpose: Background</h3> There is no systematic evidence review of the long-term survival under neither total artificial heart (TAH) nor under bi-ventricular assist device (BiVAD). <h3>Objectives</h3> Our primary objective was to determine if pooled data analysis could demonstrate that TAH reduced one-year mortality compared to BiVAD in bi-ventricular failure patients. <h3>Methods: Evidence acquisition</h3> Literature was systematically searched for monocentric studies reporting on survival under TAH or BiVAD and including at least 30 patients without limits. <h3>Results: Evidence synthesis</h3> Studies comparing TAH and BiVAD were lacking. Four studies including 299 patients and 6 studies including 198 patients reported survival under TAH and BiVAD respectively. Patients under TAH were comparable to the early RVAD cohort in terms of INTERMACS 1-2 indication, bilirubin and creatinine level, central venous and pulmonary capillary wedge pressures. On the other hand, they were significantly sicker than the late RVAD cohort. Survival at 6 and 12 months was 63% (95 % CI; 54.2-71.8) and 42.2% (95% CI; 29-55,4) respectively. Survival was comparable to that of late RVAD cohort (p=0.326) and significantly better than that the early RVAD cohort (p=0.048). <h3>Conclusion: Conclusion</h3> Pooled data analysis was limited by the lack of randomized controlled trials or cohort studies comparing outcomes of TAH and BiVAD. TAH seems to confer better one-year survival in bi-ventricular failure patient specially in sicker patients with planned RVAD.