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Original Articles: Adult Cardiac

Invited Commentary

Heart Center Northrhine-Westphalia, Ruhr-University Bochum, Georgstrasse 11, Bad Oeynhausen 32545, Germany

(Email: rkoerfer{at}hdz-nrw.de).

Copeland and colleagues [1] in reflecting their vast and groundbreaking experience in the field of total artificial heart (TAH) development and application, merit congratulations for this most interesting and necessary publication, which serves as a valuable tool in the selection of mechanical circulatory support (MCS) device selection.

Thirty-six percent of the included patients needed intra-aortic balloon counterpulsation, 42% were respiratory dependent and 19% were supported by cardiopulmonary bypass. Furthermore, 37% of the patients experienced an episode of cardiac arrest 24 hours prior to device placement. TAH support was applied quickly and consequently, before already impaired endorgan function fully deteriorated to fulminate multiorgan failure and its irreversible sequelae. This most aggressive strategy led to an excellent patient recovery to heart transplantation and very good results thereafter.

Risk factors to death for VAD placement, either LVAD or BVAD, have been clearly identified in multiple publications. Notably, most patients in this analysis had either one or more VAD risk factors for death and were therefore destined to experience very complicated clinical courses with VAD placements. Therefore, the analyzed group was too sick for VAD support, so that MCS with a TAH was initiated. This resulted in a 79% survival of this severely diseased population to transplantation and very good clinical outcomes thereafter.

Unfortunately, postoperative results depend significantly on the interval from TAH initiation to transplantation. These patients were transplanted just 79 days after TAH implantation, which facilitated the surgical procedure considerably. Long-term TAH support is associated with massive intrapericardial adhesions and significant pericardial shrinkage; therefore, a high percentage of favorable outcomes as in this analysis is not achievable.

The clinical community desperately needed this risk factor analysis to choose appropriate devices for MCS in different clinical circumstances. I strongly recommend TAH therapy to be an integral component in every cardiosurgical unit that deals with end-stage congestive heart failure and transplantation for extraordinary high-risk patients who face immediate death and have no other therapeutic options.

	References

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1. Copeland JG, Smith RG, Bose RK, Tsau PH, Nolan PE, Slepian MJ. Risk factor analysis for bridge to transplantation with the CardioWest total artificial heart Ann Thorac Surg 2008;85:1639-1645.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Reiner Koerfer Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Koerfer, R. Search for Related Content PubMed PubMed Citation Articles by Koerfer, R. Related Collections Mechanical Circulatory Assistance Related Article