INFECTIONS WITH THE CARDIOWEST TOTAL ARTIFICIAL-HEART

The CardioWest total artificial heart is a pneumatically driven device that totally replaces the failing ventricles. It is currently used as a bridge to heart transplantation in selected centers in the United S tates under a study by the Food and Drug Administration. Twenty-seven patients have undergone placement of the total artificial heart since 1993 with the intention to bridge to transplantation. Inclusion criter ia included candidacy for heart transplantation, cardiac index (CI) < 2.0 L/ min/m(2), and maximal inotropic support. The population consist ed of 25 men and 2 women of mean +/- SD age 46.5 +/- 10.3 years, body surface area 2.01 +/- 0.17 m(2), and duration of implant 52 +/- 42 day s. Initial diagnosis included ischemic cardiomyopathy (n = 10), idiopa thic (n = 10), viral (n = 4), valvular (n = 2), and graft failure (n = 1). Infectious complications were defined as systemic (evidence of le ukocytosis or fever) or local. The population experienced 64 infection s (range, 0-9 per patient): 45 systemic and 19 local. Three patients d id not experience any infection. Twenty-five patients reached transpla ntation, and were discharged home for a survival rate of 92.6%. Two pa tients died during the bridge, one because of mechanical failure, and one because of infection (mediastinitis). Therefore, death attributabl e to infections occurred in 3.7%. Previous reports of the total artifi cial heart experience in the late 1980s described death rates as high as 40%. Although infectious complications are common in patients who a re bridged to heart transplantation with the total artificial heart, m ortality from infections is 10 times less than previously reported. Th is may be the result of a better strategy for bridging to transplantat ion that includes patient selection, mobilization, early central line removal, and waiting until all possible infections are resolved before proceeding to transplantation.