title: The challenge of home discharge with a total artificial heart: the La Pitie Salpetriere experience.
abstract: OBJECTIVE
  The total artificial heart (TAH) helps to counteract the current decrease in heart donors and is likely to bridge patients to transplant under favourable conditions. Today's mobile consoles facilitate home discharge. The aim of this study was to report on the La Pitie Hospital experience with CardioWest TAH recipients, and more particularly, on generally successful outpatient' management.
  
  
  METHODS
  A retrospective analysis was performed on clinical and biological data from patients implanted with a TAH between December 2006 and July 2010 in a single institution. Morbi-mortality during hospital stay, number and causes of rehospitalizations, quality of life during home discharge, bridge to transplant results and survival have all been analysed.
  
  
  RESULTS
  Twenty-seven patients were implanted with the CardioWest. Fifteen patients (55.5%) died during support. Prior to home discharge, the most frequent cause of death was multi-organ failure (46.6%). Twelve patients were discharged home from hospital within a median of 88 days [range 35-152, interquartile range 57] postimplantation. Mean rehospitalization rate was 1.2 by patient, on account of device infection (n = 7), technical problems with the console (n = 3) and other causes (n = 4). Between discharge and transplant, patients spent 87% of their support time out of hospital. All patients who returned home with the TAH were subsequently transplanted, and 1 died in post-transplant.
  
  
  CONCLUSIONS
  Despite the morbidity and mortality occurring during the postimplantation period, home discharge with a TAH is possible. Portables drivers allow for a safe return home. Aside from some remaining weak points such as infectious complications or noise, CardioWest TAH allows for successful rehabilitation of graft candidates, and assures highly satisfactory transplant results.
authors.affiliation: Division of Cardiac Surgery, Pitié-Salpêtrière Hospital, University 'Pierre et Marie Curie', Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Demondion
authors.forename: Ludovic
authors.initials: L
authors.lastname: Fournel
authors.forename: Michaela
authors.initials: M
authors.lastname: Niculescu
authors.forename: Alain
authors.initials: A
authors.lastname: Pavie
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000601:surgery; D016027:Heart Transplantation / Q000009:adverse effects / Q000295:instrumentation*; D006354:Heart, Artificial; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Adverse event; Heart failure; Heart transplant; Home discharge; Quality of life; Total artificial heart