Benefits of the Total Artificial Heart as a Bridge to Transplant for Graft Failure Patients

For heart transplant recipients who experience graft failure, chronic allograft vasculopathy or rejection, the SynCardia temporary Total Artificial Heart (TAH) overcomes limitations associated with the use of left ventricular assist devices (LVADs) and biventricular assist devices (BiVADs) as a bridge to transplant in this population.

As of 2015, there were approximately 30,000 living heart transplant recipients in the United States. Nearly 25% of these heart transplant recipients experience acute rejection during their first year post-transplant. Additionally, graft failure is one of the most common causes of death during this time period1. Unfortunately, re-transplants are uncommon, accounting for only 2.9% of transplants in 20151.

Graft failure in heart transplant recipients often manifests as biventricular dysfunction. Therefore, LVADs may provide inadequate support as a bridge to subsequent heart transplantation. Historically, the use of LVADs as a bridge to transplant in this population has had limited success and has been associated with poor outcomes2,3. The use of BiVADs will provide biventricular support, but remains challenging because of anatomical constraints associated with small ventricles and the requirement for ongoing immunosuppression. The use of high-dose immunosuppressants in critically ill patients hinders the healing process, increases susceptibility to sepsis and heightens the risk of developing multiple organ system failure2.

The only device that allows for complete removal of the transplanted ventricles and discontinuation of all immunosuppression while the patient waits for a donor heart is the SynCardia TAH3. In addition, the 70cc TAH provides cardiac outputs up to 9.5 L/min and the 50cc TAH provides cardiac outputs up to 7.5 L/min, which promotes reversal of multiple organ system failure often seen in patients with more advanced graft failure2.

 

Reliable, Long-Term Support and Good Quality of Life

High panel reactive antibody (PRA) levels are often present in heart transplant recipients who require re-transplantation. One of the challenges of the sensitized patient awaiting transplantation is that their donor pool is limited to only compatible donors. This results in prolonged and often prohibitive waiting times and a consequential increase in wait-list mortality. Therefore, these patients may require reliable, long-term mechanical circulatory support as a bridge to transplantation while desensitization therapies are implemented.

To date, the SynCardia TAH has been used as a bridge to transplant in more than 100 graft failure patients. In addition to providing biventricular support, the TAH may reverse end-organ dysfunction and allows for increased mobility, thereby optimizing the patient’s physical condition for subsequent heart transplantation. Once clinical stability is achieved, these patients are provided with the opportunity to return home to their families and loved ones while awaiting a compatible donor heart, thus enhancing their quality of life.

 

 

Meet Our Patients

SynCardia TAH Bridges 11-Year-Old to Second Heart Transplantation

Born with hypoplastic left heart syndrome, 11-year-old Jaheim received his first heart transplant in 2012. However, four years later, tests revealed his heart was failing because of graft failure. Jaheim was immediately admitted to the hospital and treated intensively for rejection, but within several weeks, his other organ systems began to fail. To save his life, the team at Ann & Robert H. Lurie Children’s Hospital of Chicago removed his failing donor heart and implanted the 50cc TAH. Cachectic prior to implant, Jaheim gained more than 10 pounds over the next few months, and after 280 days of support with the 50cc TAH, Jaheim received his second heart transplant.

Read Jaheim’s full story here.

19-Year-Old Childhood Cancer Survivor Bridged to Second Transplant with the SynCardia TAH

As a young girl, Tiernee suffered from renal cell carcinoma. In addition to having one of her kidneys removed, she had to undergo chemotherapy, which weakened her heart. In August 2006, Tiernee received a heart transplant, but over the next few years, her body rejected the donor heart and her health began to deteriorate. Tiernee progressed to end-stage renal failure, potentially needing dialysis for the rest of her life. Doctors didn’t think she would survive the wait time for another heart transplant, so they decided to implant the SynCardia TAH. After two months, Tiernee’s kidney function returned, and after 414 days of support with the TAH, she underwent her second heart transplant.

Read Tiernee’s full story here.

 

Resources

1OPTN/SRTR 2015 Annual Data Report: Heart

2Quader MA, Tang D, Katlaps G, Shah KB, Kasirajan V. Total artificial heart for patients with allograft failure. J Thorac Cardiovasc Surg. 2013;145:e21–e23

3Kalya A, Jaroszewski D, Pajaro O, et al. Role of total artificial heart in the management of heart transplant rejection and retransplantation: case report and review. Clin Transplant 2013;27:E348-50

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