Late Surgical Bleeding Following Total Artificial Heart Implantation.
BACKGROUND
Mechanical circulatory support for heart failure, including the Total Artificial Heart (TAH, Syncardia, Tucson, AZ, USA) has increased in recent years. This report describes bleeding complications associated with the device.


METHODS
A single institution prospectively maintained quality improvement database was reviewed encompassing the first year of clinical experience with the TAH. Patients who underwent TAH implantation were identified, and a review of complications and outcomes was undertaken.


RESULTS
Ten patients underwent TAH implant. Four patients experienced delayed postoperative bleeding. In three patients the manifestation of bleeding was tamponade and evidenced by TAH decreased cardiac output. In two patients, at postoperative days 31 and 137, there was a partial disruption of the aortic anastomosis along the outer curvature with pseudoaneurysm formation. Both were repaired by primary suture closure, without use of cardiopulmonary bypass. There was no mortality attributable to bleeding.


CONCLUSIONS
TAH patients are at risk for delayed postoperative bleeding, often manifest as an acute decrease in cardiac output. Due to pulsatility and high dP/dT, bleeding from the aortic anastomosis should be considered in the differential of a patient with low flow and/or tamponade.
Department of Surgery, Division of Cardiothoracic Surgery, University of Washington Medical Center, Seattle, Washington.
Joshua L
JL
Hermsen
Department of Surgery, Division of Cardiothoracic Surgery, University of Washington Medical Center, Seattle, Washington.
Jason W
JW
Smith
Department of Surgery, Division of Cardiothoracic Surgery, University of Washington Medical Center, Seattle, Washington.
Jay D
JD
Pal
Department of Medicine, Division of Cardiology, University of Washington Medical Center, Seattle, Washington.
Claudius
C
Mahr
Department of Medicine, Division of Cardiology, University of Washington Medical Center, Seattle, Washington.
S Carolina
SC
Masri
Department of Medicine, Division of Cardiology, University of Washington Medical Center, Seattle, Washington.
Todd F
TF
Dardas
Department of Medicine, Division of Cardiology, University of Washington Medical Center, Seattle, Washington.
Richard K
RK
Cheng
Department of Surgery, Division of Cardiothoracic Surgery, University of Washington Medical Center, Seattle, Washington.
Nahush A
NA
Mokadam
D016063:Blood Loss, Surgical; D002303:Cardiac Output, Low; D002305:Cardiac Tamponade; D003937:Diagnosis, Differential; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006354:Heart, Artificial / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D019919:Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods*; D012306:Risk; D013997:Time Factors; D016896:Treatment Outcome