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Gopalan R, Mitchel H, Matushinec S, Kerr R, Bolton A, Kamin A, Sutphen L, Arabia F. Feasibility of Outpatient Hemodialysis for Patients With Total Artificial Heart: A Case Series. ASAIO J 2023; 69:e270-e273. [PMID: 37159531 DOI: 10.1097/mat.0000000000001850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
Total artificial hearts (TAH) are used in patients with end-stage heart failure as a bridge-to-transplant. AKI is a common postoperative 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. Here we discuss four cases of TAH patients from a single center who were successfully maintained on OP hemodialysis (HD). All four patients were implanted with a 70cc Syncardia TM TAH for NICM. Two patients were implanted as bridge-to-transplant (BTT); one received a heart/kidney transplant and the other received a heart transplant. Two patients were implanted as destination therapy; one was maintained on OP HD until end-of-life, and the other received a heart transplant after becoming transplant eligible. 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.
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Affiliation(s)
- Radha Gopalan
- From the Department of Advanced Heart Failure, Banner University Medical Center Phoenix, Phoenix, Arizona
| | - Hayley Mitchel
- Midwestern University Arizona College of Osteopathic Medicine, Glendale, Arizona
| | - Sarah Matushinec
- From the Department of Advanced Heart Failure, Banner University Medical Center Phoenix, Phoenix, Arizona
| | - Rabia Kerr
- From the Department of Advanced Heart Failure, Banner University Medical Center Phoenix, Phoenix, Arizona
| | - Amanda Bolton
- From the Department of Advanced Heart Failure, Banner University Medical Center Phoenix, Phoenix, Arizona
| | - Amy Kamin
- From the Department of Advanced Heart Failure, Banner University Medical Center Phoenix, Phoenix, Arizona
| | - Lucinda Sutphen
- From the Department of Advanced Heart Failure, Banner University Medical Center Phoenix, Phoenix, Arizona
| | - Francisco Arabia
- Department of Cardiothoracic Surgery, Banner University Medical Center Phoenix, Phoenix, Arizona
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Satish M, Anyanwu A, Moss N, Lala A, Itagaki S, Roldan J, Mancini D. HeartMate-3 Ventricular Assist Devices Versus the Total Artificial Heart for Biventricular Support: A Single-Center Series. ASAIO J 2023; 69:544-551. [PMID: 36867839 DOI: 10.1097/mat.0000000000001900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
INTRODUCTION The SynCardia total artificial heart (TAH) is the only device approved for biventricular support. Continuous flow ventricular assist devices (VAD) in a biventricular configuration (BiVAD) have been used with variable results. The purpose of this report was to examine differences in patient characteristics and outcomes between two HeartMate-3 (HM-3) VADs in comparison with TAH support. METHODS All patients who received durable biventricular mechanical support from November 2018 to May 2022 at The Mount Sinai Hospital (New York) were considered. Baseline clinical, echocardiographic, hemodynamic, and outcome data were extracted. Primary outcomes were postoperative survival and successful bridge-to-transplant (BTT). RESULTS A total of 16 patients received durable biventricular mechanical support during the study period, of which 6 (38%) patients received two HM-3 VAD pumps as BiVAD support and 10 (62%) patients received a TAH. Overall, TAH patients had a lower median lactate ( p < 0.05) at baseline compared to those on HM-3 BiVAD support yet had higher operative morbidity, lower 6-month survival ( p < 0.05), and a higher rate of renal failure (80 vs . 17%; p = 0.03). However, survival declined to the same rate at 1 year (50%) and was largely because of extracardiac adverse events related to underlying comorbidities (particularly, renal failure and diabetes, p < 0.05). Successful BTT was achieved in 3 out of 6 HM-3 BiVAD patients and in 5 out of 10 TAH patients. CONCLUSION In our single center experience, similar outcomes were observed among patients BTT with HM-3 BiVAD compared to those BTT on TAH support despite lower Interagency Registry for Mechanically Assisted Circulatory Support level.
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Affiliation(s)
- Mohan Satish
- From the Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai
| | - Anelechi Anyanwu
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai
| | - Noah Moss
- From the Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai
| | - Anuradha Lala
- From the Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai
| | - Shinobu Itagaki
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai
| | - Julie Roldan
- From the Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai
| | - Donna Mancini
- From the Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai
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Chen Q, Chan J, Akhmerov A, Roach A, Emerson D, Megna D, Catarino P, Moriguchi J, Chang D, Kittleson M, Geft D, Kobashigawa J, Chikwe J, Esmailian F. Heart transplantation after total artificial heart bridging-Outcomes over 15 years. Clin Transplant 2022; 36:e14781. [PMID: 35844069 PMCID: PMC9771925 DOI: 10.1111/ctr.14781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/06/2022] [Accepted: 07/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Data are limited on outcomes after heart transplantation in patients bridged-to-transplantation (BTT) with a total artificial heart (TAH-t). METHODS The UNOS database was used to identify 392 adult patients undergoing heart transplantation after TAH-t BTT between 2005 and 2020. They were compared with 11 014 durable left ventricular assist device (LVAD) BTT patients and 22 348 de novo heart transplants (without any durable VAD or TAH-t BTT) during the same period. RESULTS TAH-t BTT patients had increased dialysis dependence compared to LVAD BTT and de novo transplants (24.7% vs. 2.7% vs. 3.8%) and higher levels of baseline creatinine and total bilirubin (all p < .001). After transplantation, TAH-t BTT patients were more likely to die from multiorgan failure in the first year (25.0% vs. 16.1% vs. 16.1%, p = .04). Ten-year survival was inferior in TAH-t BTT patients (TAH-t BTT 53.1%, LVAD BTT 61.8%, De Novo 62.6%, p < .001), while 10-year survival conditional on 1-year survival was similar (TAH-t BTT 66.8%, LVAD BTT 68.7%, De Novo 69.0%, all p > .20). Among TAH-t BTT patients, predictors of 1-year mortality included higher baseline creatinine and total bilirubin, mechanical ventilation, and cumulative center volume <20 cases of heart transplantation involving TAH-t BTT (all p < .05). CONCLUSION Survival after TAH-t BTT is acceptable, and patients who survive the early postoperative phase experience similar hazards of mortality over time compared to de novo transplant patients and durable LVAD BTT patients.
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Affiliation(s)
- Qiudong Chen
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Joshua Chan
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Akbarshakh Akhmerov
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Amy Roach
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Dominic Emerson
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Dominick Megna
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Pedro Catarino
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Jaime Moriguchi
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - David Chang
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Michelle Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Dael Geft
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Jon Kobashigawa
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Fardad Esmailian
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
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