CardioWest total artificial heart: A retrospective controlled study

The CardioWest total artificial heart (TAH) is a pneumatic device that is u sed as a bridge to heart transplantation and the only TAH available that to tally replaces the failing ventricles. It has been utilized in selected cen ters in the U.S.A. with approval from the Food and Drug Administration. Str ict criteria have been developed to select candidates to be bridged with th e TAH. The patient must be a heart transplant candidate of age >18 and <59 years with a body surface area (BSA) greater than or equal to 1.7 m(2), car diac index (CI) <2.0 L/min/m(2), and 2 inotropic agents or 1 plus an intraa ortic balloon pump (IABP). A total of 24 heat transplant candidates (Group A) met the entry criteria and underwent placement of the TAH between Januar y 1993 and July 1996. Group A consisted of 23 males; 16 patients had an IAB P. The control group (Group B) consisted of 18 heart transplant candidates who mel the TAH entry criteria but never received a TAH. Group B consisted of 15 males; 14 patients had an IABP. Preimplantation pulmonary vascular re sistance (PVR) (Wood units), serum creatinine (mg/dl), and total bilirubin (mg/dl) were determined in both groups. The mean values for Groups A and B were, respectively, age: 47 and 47 years, BSA: 2.01 and 1.93 m(2), CI: 1.5 and 1.8 L/min/m(2), PVR: 2.88 and 2.47 Wood units, creatinine: 1.5 and 1.6 mg/dl, and bilirubin: 1.8 and 1.4 mgldl. In Group A, 1 patient died on the TAH, 1 patient died after transplant, and 22 patients reached transplant an d were discharged home for a survival rate of 91.7%. In Group B, 10 patient s died while waiting for a heart transplant. Of the 8 patients transplanted , 7 survived and were discharged home for a survival rate of 38.9% (p = 0.0 003). In summary the CardioWest TAH provided an excellent and successful me thod of bridging patients to heart transplantation with a reasonable risk.