Persistent anemia after implantation of the total artificial heart.
BACKGROUND
The total artificial heart (TAH) replaces the heart with 2 pneumatic pumps and 4 tilting disk mechanical valves. It was hypothesized that patients receiving TAH support have persistent hemolysis that resolves after heart transplantation (HT).


RESULTS
Hematocrit (HCT) was compared in patients on TAH to left ventricular assist device (LVAD) support for bridge to HT. Data were compared with t tests. The TAH (n = 36; mean age 47 ± 13 years) and LVAD patients (n = 14; mean age 53 ± 12 years) were supported for a median of 83 (interquartile range [IQR] 43-115) and 106 days (IQR 84-134), respectively. Hematocrit was similar between the TAH and LVAD patients (34 ± 6% vs 37 ± 5%; P = .07) at baseline. After placement, TAH patients had lower HCT at 2 (20 ± 2% vs 24 ± 3%), 4 (22 ± 3% vs 26 ± 3%), 6 (22 ± 4% vs 30 ± 4%), and 8 weeks (23 ± 4% vs 33 ± 5%; P < .001 for all). There were no differences in HCT at 1 (30 ± 4% vs 29 ± 7%; P = .42) and 3 months (35 ± 7% vs 35 ± 4%; P = .98) after removal of the devices for HT. TAH patients had undetectable haptoglobin in 96% of assessments, increased lactate dehydrogenase (1,128 ± 384 units/L), and detectable plasma free hemoglobin in 40% of measurements (21 ± 15 mg/dL). High sensitivity C-reactive protein (52 ± 50 mg/dL) was elevated, and reticulocyte production index was decreased (1.6 ± 0.6).


CONCLUSIONS
Patients implanted with a TAH have persistent anemia that resolves only after HT. The association of hemolysis, ineffective erythropoiesis, and inflammation with the TAH warrants further study.
Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia 23298, USA.
Anit K
AK
Mankad
Daniel G
DG
Tang
William B
WB
Clark
Maureen
M
Flattery
Suzanne
S
Harton
Gundars J
GJ
Katlaps
Warren K
WK
Stribling
Richard H
RH
Cooke
Michael L
ML
Hess
Vigneshwar
V
Kasirajan
Keyur B
KB
Shah
D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D002097:C-Reactive Protein / Q000378:metabolism; D004921:Erythropoietin / Q000097:blood; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006352:Heart Ventricles; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006400:Hematocrit; D006461:Hemolysis / Q000502:physiology; D006801:Humans; D008163:Luminescent Measurements; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D004921:Erythropoietin; D002097:C-Reactive Protein