Clinical application and patient selection in the use of a total artificial heart as a bridge for transplantation.
Between April 1986 and July 1987, 21 patients underwent orthotopic implantation of a total artificial heart (Jarvik 7) at La Pitié Hospital. There were 18 men and 3 women with a mean age of 37.3 +/- 11.4 years. The device implanted was the 70 ml version in 10 patients and the 100 ml version in 11 patients. In the results, three variables were analysed: age, acute myocardial decompensation or chronic myocardial failure, and aetiology of the 21 patients treated. 10 (47.6%) had adequate support and were successfully transplanted. Eleven patients (52.4%) died during circulatory support. The main causes of death were sepsis and multiple organ failure. In only one patient was a mismatch between the heart and chest cavity present. There was no clinical evidence of thromboembolic complications. Patients of 40 years of age and less have an 80% chance of being successfully transplanted in comparison with a 25% success rate in older patients. Patients that developed sudden cardiac decompensation have a 75% success rate for transplantation in comparison with 44.4% success rate in patients with a chronic illness. Early implantation of the device, before the development of irreversible damage in other organs, is recommended in younger patients with acute or chronic disease and in older patients with acute myocardial failure. The use of this device is contraindicated in immunosuppressed patients due to the high risk of infection.
Solis
E
E
Department of Cardiovascular Surgery, Hospital La Pitié, Paris, France.
Leger
P
P
Muneretto
C
C
Gandjbakhch
I
I
Pavie
A
A
Bors
V
V
Piazza
C
C
Szefner
J
J
Cabrol
A
A
Cabrol
C
C
D000328:Adult; D000367:Age Factors; D009202:Cardiomyopathies / Q000150:complications; D003327:Coronary Disease / Q000150:complications; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality; D006354:Heart, Artificial; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D011379:Prognosis; D015996:Survival Rate