Is the Total Artificial Heart Superior to BIVAD Therapy
as a Method of Bridging Patients to Heart Transplantation? 

The information below was presented as a poster at the Society of Thoracic Surgeons (STS) 43rd Annual Meeting, January 2007.

Bradley G. Leshnower MD¹, Richard G. Smith MSEE², Mary Lou O’Hara RN, Y. Joseph Woo MD, Alberto Pochettino MD, Rohinton J. Morris MD, Timothy J. Gardner MD³, Marvin J. Slepian MD², Jack G. Copeland, MD², Michael A. Acker MD

¹ Division of Cardiovascular Surgery Hospital of the University of Pennsylvania  , ²The University of Arizona Sarver Heart Center , ³Center for Heart and Vascular Health, Christiana Care Health System ³

Objective:  The optimal treatment for end-stage heart failure is transplantation. The lack of donor organs has led to the development of Ventricular Assist Device (VAD) and Total Artificial Heart (TAH), which can bridge patients to transplant. These two devices represent different strategies of mechanical circulatory support. In order to determine the optimal method of supporting the circulation in patients with biventricular failure awaiting transplantation, we compared the results of patients who received total cardiac replacement to those who received support of their native heart with biventricular assist device (BIVAD) therapy.

Methods: A retrospective review of the VAD database at the Hospital of the University of Pennsylvania identified 90 patients who received BIVAD support from October 1995-August 2005. These results were compared to a cohort of 61 patients who received the CardioWest (SynCardia Systems, Tucson, AZ) TAH at the University of Arizona Sarver Heart Center from January 1993-December 2001.

Results:

• Pre-operative characteristics of the two cohorts are listed (Table 1). Ischemic heart disease was the predominant etiology of heart failure in both groups.
• Compared to the BIVAD group, patients receiving the TAH had a longer length of mechanical support, and significantly lower incidence of stroke and re-operation. Despite a higher incidence of infection, the TAH was a more successful device in bridging patients to transplantation. Consequently, patients receiving a TAH were more likely to be discharged from the hospital after transplantation (Table 2).

The above charts were created by SynCardia to display the statistics discussed in this poster.

Conclusion: When bridging patients with biventricular failure to heart transplantation, total cardiac replacement appears to confer morbidity and mortality benefits over biventricular support with ventricular assist devices. 

Disclosures:

• Mr. Smith and Dr. Slepian report owning equity in SynCardia Systems and being paid for part-time employment by the company.
• Dr. Copeland reports owning equity in SynCardia Systems, the manufacturer
  of the CardioWest Total Artificial Heart.