title: Synthetic membrane neo-pericardium facilitates total artificial heart explantation.
abstract: BACKGROUND
  In the past, explantation of the Cardio West total artificial heart (TAH) has been technically challenging because of the presence of dense adhesions and extremely thickened pericardium. To prevent this, we constructed a synthetic neo-pericardium in 14 patients.
  
  
  METHODS
  Using expanded polytetrafluoroethylene (e-PTFE) membrane, we constructed a pericardium within the pericardium, or "neo-pericardium," completely covering the Cardio West TAH separating the native atria from the native pericardium, and wrapping the ascending aorta from the outflow conduit distally 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 throughout the pericardial space became apparent immediately after e-PTFE membrane removal. The pericardium and related tissues although slightly thickened (<2 mm) were pliable compared with our previous 36 patients, with very thick adherent pericardium over the device and native atria.
  
  
  CONCLUSIONS
  The plastic materials forming the ventricular housing and drivelines of the Cardio West TAH and the Dacron outflow conduits have in the past caused profound local inflammatory reactions, resulting in extremely dense 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 pericardial thickening and facilitates explantation.
authors.affiliation: University of Arizona Sarver Heart Center, Tucson, Arizona 85724, USA. jgc@u.arizona.edu
authors.forename: J G
authors.initials: JG
authors.lastname: Copeland
authors.forename: F A
authors.initials: FA
authors.lastname: Arabia
authors.forename: R G
authors.initials: RG
authors.lastname: Smith
authors.forename: D
authors.initials: D
authors.lastname: Covington
mesh_terms: D000328:Adult; D001011:Aorta / Q000473:pathology; D006348:Cardiac Surgical Procedures / Q000379:methods*; D020878:Device Removal / Q000379:methods*; D004867:Equipment Design / Q000295:instrumentation*; D006354:Heart, Artificial; D006801:Humans; D008875:Middle Aged; D010493:Pericarditis / Q000517:prevention & control; D010496:Pericardium / Q000601:surgery*; D011138:Polytetrafluoroethylene
chemical_list: D011138:Polytetrafluoroethylene