INTERNATIONAL EXPERIENCE WITH THE CARDIOWEST TOTAL ARTIFICIAL-HEART AS A BRIDGE TO HEART-TRANSPLANTATION

As the number of potential heart donors remains constant and the numbe r of potential recipients continuous to increase, the need for circula tory devices to bridge patients becomes more important. The CardioWest total artificial heart (TAH) is a pneumatic, implantable system that totally replaces the failing ventricles. It has been utilized worldwid e as a bridge to heart transplantation in 79 patients. There were 73 m ales and six females who received the TAH. Currently three patients re main on the device waiting for transplantation. A total of 55 patients (70%) were transplanted of which 50 survived (91% of patients transpl anted) and were discharged home. Idiopathic/dilated cardiomyopathy was the most common etiology followed by ischemic cardiomyopathy. The mea n duration of implant was 34 days (range 0-186 days) and the mean age of the group was 45 years (range 16-62 years). Twenty-one patients die d while on the device. Multiple organ failure was the major cause of d eath. There were a total of 255 complications in this group that inclu ded reoperation, bleeding, hepatic failure, renal failure, respiratory failure, neurologic events, thromboembolic events, infections, device malfunction? and fit complications. This represented a mean complicat ion rate of three events per patient. The survival rate for the Cardio West TAH of 91% of the patients who reached transplantation is an impr ovement over that of the Symbion registry (55% of those transplanted) probably as a result of a better patient selection and better control of the coagulation system. These results are also comparable to those survival results obtained with other biventricular and left ventricula r assist devices currently available. (C) 1997 Elsevier Science B.V.