title: Total Artificial Heart as Bridge to Heart Transplantation in Chagas Cardiomyopathy: Case Report.
abstract: Chagas disease (CD) is becoming an increasingly recognized cause of dilated cardiomyopathy outside of Latin America, where it is endemic, due to population shifts and migration. Heart transplantation (HTx) is a therapeutic option for end-stage cardiomyopathy due to CD, but may be considered a relative contraindication due to potential reactivation of the causative organism with immunosuppression therapy. The total artificial heart (TAH) can provide mechanical circulatory support in decompensated patients with severe biventricular dysfunction until the time of HTx, while avoiding immunosuppressive therapy and removing the organ most affected by the causative organism. We report herein a patient with CD and severe biventricular dysfunction, who had mechanical circulatory support with a TAH for more than 6 months, followed by successful orthotopic HTx and treatment with benznidazole for 3 months. The patient had no evidence of recurrent disease in the transplanted heart based on endomyocardial biopsy up to 1 year post-transplantation, and remains alive more than 30 months after insertion of a TAH and 24 months after HTx.
authors.affiliation: Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA.
authors.forename: A
authors.initials: A
authors.lastname: Ruzza
authors.affiliation: Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA. Electronic address: lawrence.czer@cshs.org.
authors.forename: L S C
authors.initials: LS
authors.lastname: Czer
authors.affiliation: Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA.
authors.forename: M
authors.initials: M
authors.lastname: De Robertis
authors.affiliation: Department of Pathology, Cedars Sinai Medical Center, Los Angeles, California, USA.
authors.forename: D
authors.initials: D
authors.lastname: Luthringer
authors.affiliation: Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA.
authors.forename: J
authors.initials: J
authors.lastname: Moriguchi
authors.affiliation: Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA.
authors.forename: J
authors.initials: J
authors.lastname: Kobashigawa
authors.affiliation: Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA.
authors.forename: A
authors.initials: A
authors.lastname: Trento
authors.affiliation: Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA.
authors.forename: F
authors.initials: F
authors.lastname: Arabia
mesh_terms: D002598:Chagas Cardiomyopathy / Q000150:complications / Q000601:surgery*; D005260:Female; D016027:Heart Transplantation / Q000379:methods*; D006354:Heart, Artificial; D006801:Humans; D008875:Middle Aged; D009593:Nitroimidazoles / Q000627:therapeutic use; D016896:Treatment Outcome; D014344:Trypanocidal Agents / Q000627:therapeutic use; D018754:Ventricular Dysfunction / Q000469:parasitology / Q000601:surgery
chemical_list: D009593:Nitroimidazoles; D014344:Trypanocidal Agents; C009999:benzonidazole