Creation of a Self-Made Total Artificial Heart Using Combined Components of Available Ventricular Assist Devices

Abstract

We describe the case of a 39-year-old woman who received a self-made total artificial heart built of components from the Thoratec and ExCor Berlin Heart systems. The patient had a severe aortic/myocardial infection following replacement of the ascending aorta with a Shelhigh conduit due to type A aortic dissection. The surgical technique is described in detail in this article. This technique is feasible if a total artificial heart is not available and implantation of a biventricular assist device is not possible.

Extracorporeal total artificial heart as bailout surgery

“…Almost all surgeons chose to explant the heart and remove the AV annulus, creating neo‐atria using different techniques, as in our patient. Only Tjan et al and Strueber et al preserved the AV annulus, and built neo‐ventricles.…”

“…They where extracorporeal pulsatile devices for 28 of the patients, mainly the Thoratec biventricular device (Thoratec Corp). Robinson et al used the AB5000 (Abiomed Inc., Danvers, MA), and Tjian et al used the ExCor BerlinHeart pump (BerlinHeart, Berlin, Germany) . An intracorporeal continuous flow device was used in three patients (HeartMate II, Thoratec Corp) and a Heartware Ventricular Assist Device (Heartware International, Inc, Framingham, MA) in one patient …”

“…Most teams report planned surgeries; only Tjan et al and Strueber et al were faced with a urgent situation and made the decision to explant the heart intra‐operatively. Both patients survived to transplantation and hospital discharge.…”

“…Tjan et al and Strueber et al chose this approach but the latter used the apical sewing ring of the HeartWare device on the ventricular side of the annulus, instead of grafts, in accordance with the device they chose to implant.…”

“…Most patients received two extracorporeal pulsatile devices, and since 2011 some teams used intracorporeal devices . One team created their own VADs using components of the Thoratec extracorporeal device and the ExCor BerlinHeart . We used a Levitronix CentriMag LVAD, as it is a short‐term device used regularly in our center.…”