Machines Versus Medication for Biventricular Heart Failure: Focus On the Total Artificial Heart

Abstract

The medical/surgical management of advanced heart failure has evolved rapidly over the last few decades. With better understanding of heart failure pathophysiology, new pharmacological agents have been introduced that have resulted in improvements in survival. For those patients that fail to improve, mechanical circulatory support with left ventricular assist devices and total artificial hearts (TAHs) have served as a beneficial bridge to transplantation. The TAH has continued to play a significant role as a bridge to transplantation in patients with biventricular failure and more selected indications that could not be completely helped with left ventricular assist devices. Improved survival with the TAH has resulted in more patients benefiting from this technology. Improvements will eventually lead to a totally implantable device that will permanently replace the failing human heart.

Interagency registry for mechanically assisted circulatory support report on the total artificial heart

“…Rebridging with a TAH-t has been successful in some patients who experience LVAD/BiVAD failure. 38 The challenges for early MCS referral continue to be multifactorial. The timing of referral and intervention might make the difference for some etiologies between successful implant of an LVAD and irreversible RV dysfunction requiring a TAH-t.…”

Assessing Cerebrovascular Hemodynamics Using Transcranial Doppler in Patients with Mechanical Circulatory Support Devices

“…Early survival after implantation is satisfactory, although at times at the expense of device‐related complications 1‐3 . Significant improvement of the hardware and implantation procedure has greatly reduced device failure 4‐6 . Neurologic adverse events continue to represent a significant challenge to the long‐term outcomes after MCS device placement 2,5,7‐11 …”

American Association for Thoracic Surgery/International Society for Heart and Lung Transplantation guidelines on selected topics in mechanical circulatory support

“…Biventricular failure (BVF) occurs when both chambers of the heart show evidence of inadequate forward flow with appropriate filling pressures, compromising adequate oxygen delivery and maintenance of normal physiologic function. 76,77 The etiology for RV failure 78 can be primary, electromechanical in nature, or secondary to LV and/or pulmonary etiologies. Furthermore, RV failure can be transient and respond to medical management and/or temporary mechanical support or might be irreversible or unresponsive to the best management.…”