title: Home discharge and out-of-hospital follow-up of total artificial heart patients supported by a portable driver system.
abstract: To enhance ambulation and facilitate hospital discharge of total artificial heart (TAH)-supported patients, we adapted a mobile ventricular assistance device (VAD) driver (Excor) for TAH use and report on the performance of Excor-driven TAH patients discharged home. Ten patients stabilized on a TAH, driven by the CSS ("Circulatory Support System"), were progressively switched over to the Excor in hospital over 14 days as a pilot, with daily hemodynamics and laboratory parameters measured. Twenty-two stable TAH patients were subsequently placed on the Excor, trained, and discharged home. Clinical and hemodynamic parameters were followed. All pilot study patients were clinically stable on the Excor, with no decrease in TAH output noted (6.3 + 0.3 L/min [day 1] vs. 5.8 + 0.2 L/min [day 14], p = 0.174), with a trend suggesting improvement of both hepatic and renal function. Twenty-two TAH patients were subsequently successfully discharged home on the portable driver and were supported out of hospital for up to 598 days (range, 2-598; mean = 179 ± 140 days), remaining ambulatory, New York Heart Association (NYHA) class I or II, and free of readmission for 88.5% of the time of support. TAH patients may be effectively and safely supported by a mobile drive system. As such, the utility of the TAH may be extended to support patients beyond the hospital, at home, with overall ambulatory freedom.
authors.affiliation: From the *Penn State Milton S. Hershey Medical Center, Heart and Vascular Institute, Hershey, PA; †Heart and Diabetes Center North Rhine-Westphalia, Department of Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany; ‡Berlin Heart, Berlin, Germany; and §Sarver Heart Center, University of Arizona, Tucson, AZ.
authors.forename: Aly
authors.initials: A
authors.lastname: El Banayosy
authors.forename: Lukacz
authors.initials: L
authors.lastname: Kizner
authors.forename: Latif
authors.initials: L
authors.lastname: Arusoglu
authors.forename: Michael
authors.initials: M
authors.lastname: Morshuis
authors.forename: Christof
authors.initials: C
authors.lastname: Brehm
authors.forename: Reiner
authors.initials: R
authors.lastname: Koerfer
authors.forename: Christoph
authors.initials: C
authors.lastname: Schuermann
authors.forename: Richard G
authors.initials: RG
authors.lastname: Smith
authors.forename: Jack G
authors.initials: JG
authors.lastname: Copeland
authors.forename: Marvin J
authors.initials: MJ
authors.lastname: Slepian
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006354:Heart, Artificial; D006439:Hemodynamics; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010865:Pilot Projects