Patient Management

SynCardia Total Artificial Heart (TAH) patients are effectively heart transplant recipients with four mechanical valves. They have a near-normal CVP, normal physiology and the source of their heart failure has been eliminated through biventricular replacement. In addition, there are no inotropes or anti-rejection medications needed.

TAH patients benefit from high cardiac output, typically 7 L/min ±1 for the 70cc TAH (max: 9.5 L/min) and 5 L/min ±1 for the 50cc TAH (max: 7.5 L/min). When patients exercise, there is never a need to adjust the driver settings, as cardiac output will change based on the patient’s activity level.

ICU Best Practices

  • Use extreme caution when placing central lines to avoid the right or left atrium/inflow valve
  • No CPR, pacing or defibrillation
    • No electrical activity since native ventricles have been removed
    • CPR is ineffective since ventricles are made of hard polyurethane
  • Maintain patient in a normotensive state
  • Volume – run dry!
  • Avoid blood replacement if possible, unless there is active bleeding or the patient is symptomatic
    • Largest consumer of Hgb and O2 in the body has been removed, so Hgb/HCT are frequently lower than expected
    • Some SynCardia Certified Centers tolerate Hgb as low as 6 g/dL and HCT as low as 17% as long as the patient is hemodynamically stable and asymptomatic1,2
  • Maintain normal blood pressure – manage pharmacologically
    • Changing the driver settings will not change blood pressure
  • Antithrombotic management is geared towards the four mechanical valves
    • No special TAH protocol is necessary
    • PTT > 50 and INR 2.5 – 3.0 are typical

Step-Down Unit Best Practices

  • Reduce lab draws unless decision needed
  • Driveline site:
    • Maintain standard of care with dressing changes at the cannula exit site, but all dressing changes/cleaning must happen over the velour only.
    • Allow only water to come in contact with the clear part of the cannula – avoid chlorhexidine, alcohol wipes, paper tape, tegaderm or any other adhesives.
  • Exercise
    • Implement a cardiac rehab program ASAP
  • Prepare for discharge with the Freedom® Portable Driver:
    • Train early and identify the caregiver
    • Conduct thorough assessment of support systems, including caregivers’ needs and availability of community resources.

1 Yaung J, Arabia FA, Nurok M. Perioperative Care of the Patient With the Total Artificial Heart. Anesthesia & Analgesia. 2017;124(5):1412-1422. doi:10.1213/ane.0000000000001851.

2 Maymi MA, Gupta D, Barras WE, et al. Pediatric Mechanical Circulatory Support. Journal of Pediatric Critical Care. 2014;1(3):190.