Implantation of Cardio West Total Artificial Heart for Irreversible Acute Myocardial Infarction Shock

Abstract

Patients who develop cardiogenic shock after acute myocardial infarction have a very high mortality rate despite early reperfusion therapy. Hemodynamic stabilization can often only be achieved by implanting a mechanical circulatory support system. When, in cases representing expansive myocardial impairment without any chance of recovery, pharmacological therapy and the use of percutaneous assist devices have failed, the implantation of a total artificial heart is indicated. We report our first experiences with this extensive and innovative method of managing irreversible cardiogenic shock patients. The CardioWest total artificial heart was implanted in 5 patients (male; mean age, 50 years). All patients were in irreversible cardiogenic shock despite maximum dosages of catecholamines, an intra-aortic balloon pump and/or a femoro-femoral bypass. In all patients early reperfusion therapy was performed. After implantation of the Cardio West system, all dysfunctional organ systems rapidly recovered in all patients. Four of 5 patients underwent successful heart transplantation after a mean support time of 156 days. One patient died because of enterocolic necroses caused by an embolic event after termination of dicumarol therapy. In summary, our first experiences justify this extensive management in young patients who would otherwise have died within a few hours.

Physiologic Benefits of Pulsatile Perfusion During Mechanical Circulatory Support for the Treatment of Acute and Chronic Heart Failure in Adults

“…A 2007 study at the University Hospital of the Ruhr‐University of Bochum showed that five patients with irreversible cardiogenic shock refractory to conventional drug therapy implanted with CardioWest TAH rapidly recovered from vital organ dysfunction. Four of the five patients received successful heart transplant (43). Initial experience with the AbioCor at the University of Louisville School of Medicine demonstrated that despite cases of mortality due to preexisting illness, seven patients ineligible for heart transplant exhibited proper TAH functioning with the AbioCor.…”

Mechanical Circulatory Support for AMI and Cardiogenic Shock

“…All 13 patients implanted with the TAH survived to heart transplantation after a mean duration of 5.2 days 34 . Successful utilization of the TAH as a bridge to transplant in patients with AMI and cardiogenic has also been reported by Morshuis and colleagues 35 …”

The CardioWest Total Artificial Heart for Chronic Heart Transplant Rejection

“…3,4 Further, Copeland et al demonstrated that risk factors after CardioWest TAH implantation as a bridge to transplantation in biventricular heart failure patients, including those with irreversible cardiac rejection, were a history of smoking and prolonged prothrombin time, without including chronic heart transplant rejection. 5 As an advantage, the cardiac output of the CardioWest TAH is generally 7-8 L/min, which not only improves pressure and flow to end organs, but also increases the "washing" of the device's surfaces that are in contact with blood, thus reducing the risk of thromboembolism.…”