Several case studies suggest that real-time pulmonary artery (PA) pressure readings may provide accurate assessment of pulmonary pressure in patients implanted with the SynCardia temporary Total Artificial Heart (TAH), which may facilitate medical management and assessment of timing for heart transplant — learn more about this emerging approach.
For patients with elevated PA pressures and pulmonary vascular resistance (PVR), cardiac transplantation may not be feasible because of the risk of right ventricular failure after transplantation and poor survival outcomes observed in heart transplant recipients with irreversible pulmonary hypertension (PHT).1
PHT reversal has been observed in some patients using a left ventricular assist device (LVAD) as a bridge to transplant.2 However, LVADs are contraindicated in patients with PHT who also experience right ventricular failure. These patients require biventricular support to optimize outcomes.
The SynCardia TAH is the only commercially approved bridge-to-transplant device capable of providing long-term biventricular replacement, making it a viable alternative for patients who are not candidates for LVAD implantation. However, implantation of the TAH precludes subsequent hemodynamic monitoring using Swan-Ganz catheters and right heart catheterization during TAH support because of the presence of the two mechanical valves in the right ventricle.
One potential means for performing hemodynamic monitoring while on TAH support may be the CardioMEMS™ Heart Failure System (St. Jude Medical/Abbott, MN). This FDA-approved device is a small, wireless pressure sensor that is implanted percutaneously in the PA. This sensor transmits real-time PA hemodynamics data, eliminating the need for Swan-Ganz catheter insertion or right heart catheterization.
Several case reports have been published in peer-reviewed medical journals on the use of CardioMEMS™ in recipients of the SynCardia TAH who presented with severe PHT. Though this approach has only been used a handful of times, early findings suggest that for select patients, a combined strategy using an implantable PA pressure monitor like CardioMEMS™ prior to TAH implant may be useful in medical management of the patient and assessment of timing for heart transplantation.
1 Gohar S, Taimeh Z, Morgan J, et al. Use of Remote Pulmonary Artery Pressure Monitoring (CardioMEMS System) in Total Artificial Heart to Assess
Pulmonary Hemodynamics for Heart Transplantation. ASAIO Journal. 2017:1-3. doi:10.1097/mat.0000000000000726.
2 Joyce D, Redfield M, Kushwaha S, Behfar A, Borlaug B, Daly R, Sandhu G, Joyce L: Pulmonary Pressure Assessment with the Total Artificial Heart, 2017
Published Case Reports
Pulmonary Pressure Assessment with the Total Artificial Heart
Use of Remote Pulmonary Artery Pressure Monitoring (CardioMEMS System) in Total Artificial Heart to Assess Pulmonary Hemodynamics for Heart Transplantation
Combined Total Artificial Heart and Pulmonary Thromboendarterectomy in End Stage Biventricular failure and Group IV Pulmonary Hypertension as Bridge-to-Candidacy