Ann Thorac Surg 2005;80:1133
© 2005 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Swan-Ganz Monitoring of the AbioCor Artificial Heart
Louis E. Samuels, MD
*
,
Elena C. Holmes, CRNP,
John C. Entwistle, III, MD, PhD
Hahnemann University Hospital, Philadelphia, Pennsylvania
* Address reprint requests to Dr Samuels, Lankenau Hospital, MSB Suite 280, 100 Lancaster Ave, Wynnewood, PA19096. (Email: samuelsle{at}aol.com).
| Dr Samuels discloses that he has a financial relationship with Abiomed, Inc.
|
The AbioCor totally implantable artificial heart (Abiomed, Inc, Danvers, MA) was designed as a permanent therapy for patients with end-stage biventricular heart failure who were not candidates for cardiac transplantation. The implantation is performed in a similar fashion as an orthotopic heart transplant. There are Dacron (DuPont, Wilmington, DE) artificial atria, ascending aorta, and main pulmonary artery. Plastic trileaflet prostheses serve as atrioventricular and ventriculoarterial valves. Placement of a Swan-Ganz catheter is not routine because of the concern with catheter-induced valve regurgitation (observed in the animal studies), damage to the artificial valves, and infection risk. Estimation of the pulmonary artery pressure is determined by a sensor reading of the right hydraulic pressure, which is displayed on the device console.
On November 5, 2001 the fifth AbioCor totally implantable artificial heart (Abiomed, Inc, Danvers, MA) was placed into a 51-year-old man with end-stage biventricular failure. He was deemed ineligible for transplantation because of elevated and fixed pulmonary hypertension.
Following placement of the device, the right hydraulic pressure (RHP) showed that the pulmonary artery pressure (PAP) remained elevated. Over the course of several months, the RHP steadily increased to near systemic levels. In order to determine the accuracy of the RHP sensor, a Swan-Ganz catheter was placed by the femoral approach with fluoroscopic guidance (Fig 1—course of Swan-Ganz catheter through the right atrium, right atrioventricular artificial valve, artificial right ventricle, right ventriculoarterial artificial valve, into the pulmonary arterial Dacron tube graft, and into the native right pulmonary artery). The correlation of the direct measurement with the RHP reading is shown in Fig 2. The actual PAP recording from the catheter was 10 to 15 mm Hg higher than the RHP sensor reading. This information was instructive for two reasons: 1) the RHP underestimated the actual PAP, and 2) the persistent elevated and fixed PAP did not change with total heart replacement. The patient remained on the AbioCor as destination therapy for approximately 10 months, but eventually succumbed to a cerobrovascular accident.
No adverse events occurred during catheter placement. This report documents the technical aspects of placing a catheter through the AbioCor heart as well as to confirm the RHP sensor’s estimate of the pulmonary artery pressure. These findings may impact on the future role of the AbioCor as a destination or bridging therapy.
