Synthetic membrane neo-pericardium facilitates total artificial heart explantation

Background: In the past, explantation of the Cardio West total artificial h eart (TAH) has been technically challenging because of the presence of dens e adhesions and extremely thickened pericardium. To prevent this, we constr ucted a synthetic neo-pericardium in 14 patients. Methods: Using expanded polytetrafluoroethylene (e-PTFE) membrane, we const ructed a pericardium within the pericardium, or "neo-pericardium," complete ly covering the Cardio West TAH separating the native atria from the native pericardium, and wrapping the ascending aorta from the outflow conduit dis tally for about 5 to 7 cm. Results: Of the 14 patients, 9 were transplanted and could be evaluated, 3 died on device support, and 2 are currently on device support. In each case , we attained faster (by 25 minutes) and easier reentry through the sternum . Surgical planes around the aorta, over the right and left atria, and thro ughout the pericardial space became apparent immediately after e-PTFE membr ane removal. The pericardium and related tissues although slightly thickene d (<2 mm) were pliable compared with our previous 36 patients, with very th ick adherent pericardium over the device and native atria. Conclusions: The plastic materials forming the ventricular housing and driv elines of the Cardio West TAH and the Dacron outflow conduits have in the p ast: caused profound local inflammatory reactions, resulting in extremely d ense adhesions and thickened adherent pericardium. Using e-PTFE membrane to fashion a complete neo-pericardium and to wrap the ascending aorta at the time of Cardio West implantation dramatically reduces adhesions and pericar dial thickening and facilitates explantation.