European Journal of Cardio-Thoracic Surgery, Vol 2, 65-71, Copyright © 1988 by European Association for Cardio-thoracic Surgery
Clinical application and patient selection in the use of a total artificial heart as a bridge for transplantation
E Solis, P Leger, C Muneretto, I Gandjbakhch, A Pavie, V Bors, C Piazza, J Szefner, A Cabrol and C Cabrol
Department of Cardiovascular Surgery, Hospital La Pitie, Paris, France.
Between April 1986 and July 1987, 21 patients underwent orthotopic
implantation of a total artificial heart (Jarvik 7) at La Pitie Hospital.
There were 18 men and 3 women with a mean age of 37.3 +/- 11.4 years. The
device implanted was the 70 ml version in 10 patients and the 100 ml
version in 11 patients. In the results, three variables were analysed: age,
acute myocardial decompensation or chronic myocardial failure, and
aetiology of the 21 patients treated. 10 (47.6%) had adequate support and
were successfully transplanted. Eleven patients (52.4%) died during
circulatory support. The main causes of death were sepsis and multiple
organ failure. In only one patient was a mismatch between the heart and
chest cavity present. There was no clinical evidence of thromboembolic
complications. Patients of 40 years of age and less have an 80% chance of
being successfully transplanted in comparison with a 25% success rate in
older patients. Patients that developed sudden cardiac decompensation have
a 75% success rate for transplantation in comparison with 44.4% success
rate in patients with a chronic illness. Early implantation of the device,
before the development of irreversible damage in other organs, is
recommended in younger patients with acute or chronic disease and in older
patients with acute myocardial failure. The use of this device is
contraindicated in immunosuppressed patients due to the high risk of
infection.
