Clinical application and patient selection in the use of a total artificial heart as a bridge for transplantation

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Abstract
Between April 1986 and July 1987, 21 patients underwent orthotopicimplantation 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. Thedevice implanted was the 70 ml version in 10 patients and the 100 mlversion in 11 patients. In the results, three variables were analysed: age,acute myocardial decompensation or chronic myocardial failure, andaetiology of the 21 patients treated. 10 (47.6%) had adequate support andwere successfully transplanted. Eleven patients (52.4%) died duringcirculatory support. The main causes of death were sepsis and multipleorgan failure. In only one patient was a mismatch between the heart andchest cavity present. There was no clinical evidence of thromboemboliccomplications. Patients of 40 years of age and less have an 80% chance ofbeing successfully transplanted in comparison with a 25% success rate inolder patients. Patients that developed sudden cardiac decompensation havea 75% success rate for transplantation in comparison with 44.4% successrate in patients with a chronic illness. Early implantation of the device,before the development of irreversible damage in other organs, isrecommended in younger patients with acute or chronic disease and in olderpatients with acute myocardial failure. The use of this device iscontraindicated in immunosuppressed patients due to the high risk ofinfection.

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