Tissue Expander as a Routine Component of 50cc Total Artificial Heart Implantation for Bridge to Transplant
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Definitive therapy of advanced heart failure, as classified by the American College of Cardiology/American Heart Association guidelines, is complicated because of the lack of donor organs for transplantation.1 This shortage has established a need for alternative heart failure therapies. In 2004, the Food and Drug Administration approval of a 70cc total artificial heart (TAH; SynCardia Systems Inc, Tucson, AZ) served as a valuable new treatment option offering a bridge to transplant, although patients await a donor heart.
Recent studies demonstrated that the 70cc TAH has been successfully placed in 1300 patients worldwide and has served as a successful bridge to transplant in 79% of patients.2 However, the invasive removal of the atria and ventricles during placement of the TAH carries risks. Hematologic risks include hemopericardium and coagulopathy, which may further result in either pulmonary or neurological embolic events. The implanted device itself is not without risk given reported instances of infections, leaks, and malfunctioning-related kinking of either the TAH components surgical anastomoses or the drive lines. Despite the seriousness of the complications related to the 70cc TAH, these risks can be acceptably minimized with patient education relating to proper TAH care and with an appropriate social support network.
Given the ability to manage and prevent device complications after implantation, a critical pretransplant complication that must be assessed before TAH placement is proper device fit within the patient’s thoracic cavity given the varying intrathoracic space related to body habitus and age-related difference. Although a body surface area of 1.7 to 2.5 cm2 has …