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Kronfli AP, Bixby CE, Brehm C, Soleimani B. Late Cardiac Tamponade 4 Years After Total Artificial Heart Implantation. Ann Thorac Surg 2020; 111:e267-e269. [PMID: 32987020 DOI: 10.1016/j.athoracsur.2020.06.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/16/2020] [Accepted: 06/28/2020] [Indexed: 11/30/2022]
Abstract
Cardiac tamponade after ventricular assist device or total artificial heart implantation can typically occur within days or weeks after surgery. This report describes the case of a woman who presented over 4 years after SynCardia 70cc total artificial heart implantation, with physiology consistent with right ventricular outflow tract obstruction. The cause was initially attributed to device membrane failure based on the device console waveform; however, during operative exploration, a large amount of proteinaceous exudate was surrounding the device and causing the obstruction. This report illustrates how tamponade can result years after device implantation, secondary to porosity of the outflow grafts.
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Affiliation(s)
- Anthony P Kronfli
- Department of Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.
| | - Catherine E Bixby
- Department of Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Christopher Brehm
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Behzad Soleimani
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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Maynes EJ, O’Malley TJ, Luc JGY, Weber MP, Horan DP, Choi JH, Patel S, Abbas Rizvi SS, Morris RJ, Entwistle JW, Massey HT, Tchantchaleishvili V. Comparison of SynCardia total artificial heart and HeartWare HVAD biventricular support for management of biventricular heart failure: a systematic review and meta-analysis. Ann Cardiothorac Surg 2020; 9:69-80. [PMID: 32309154 PMCID: PMC7160621 DOI: 10.21037/acs.2020.03.07] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/24/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The aim of this study was to compare the outcomes of patients undergoing SynCardia total artificial heart (TAH) and biventricular HeartWare ventricular assist device (Bi-HVAD) support for biventricular heart failure (HF). METHODS Electronic search was performed to identify all relevant studies detailing patients who underwent biventricular assist device implantation using Bi-HVAD devices and those who underwent TAH placement for biventricular HF. Twelve studies including 512 patients in the TAH group versus 38 patients in the Bi-HVAD group were pooled for meta-analysis. RESULTS Ischemic cardiac etiology was present in 32% (95% CI, 24-47) of TAH vs. 15% (95% CI, 4-44) of Bi-HVAD patients (P=0.21). There was a comparable incidence of stroke [TAH 11% (95% CI, 7-16) vs. Bi-HVAD 13% (95% CI, 2-51), P=0.86] and acute kidney injury [TAH 28% (95% CI, 2-89) vs. Bi-HVAD 27% (95% CI, 9-59), P=0.98]. Overall infection rate was 67% (95% CI, 47-82) in TAH and 36% (95% CI, 10-74) in Bi-HVAD (P=0.16). Driveline infections were comparable between the two groups [TAH 11% (95% CI, 6-19) vs. Bi-HVAD 8% (95% CI, 1-39), P=0.73] and although a higher incidence of mediastinitis was found in the Bi-HVAD group [TAH 4% (95% CI, 2-7) vs. Bi-HVAD 15% (95% CI, 4-45), P=0.07] there was no statistically significant difference between the groups. Postoperative bleeding was present in 42% (95% CI, 28-58) of TAH vs. 23% (95% CI, 8-52) of Bi-HVAD (P=0.22). Patients in the TAH group had shorter duration of support [TAH 71 days (95% CI, 15-127) vs. Bi-HVAD 167 days (95% CI, 116-217), P=0.01]. At the mean follow-up time of 120 days, (95% CI, 83-157) patients in both groups had similar overall mortality [TAH 36% (95% CI, 22-49) vs. Bi-HVAD 26% (95% CI, 6-46), P=0.44] including mortality on device support [TAH 26% (95% CI, 17-36) vs. Bi-HVAD 21% (95% CI, 4-37), P=0.55]. Discharge home on support was achieved in 6% (95% CI, 4-17%) of TAH patients vs. 73% (95% CI, 48-89%) of Bi-HVAD (P<0.01), and 68% (95% CI, 52-84) of TAH patients were transplanted vs. 61% (95% CI, 47-75) in the Bi-HVAD group (P=0.14). CONCLUSIONS Patients on Bi-HVAD support were more likely to be able to be discharged home on support and had similar overall mortality to TAH, albeit with much longer duration of support.
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Affiliation(s)
- Elizabeth J. Maynes
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Thomas J. O’Malley
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jessica G. Y. Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew P. Weber
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dylan P. Horan
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jae Hwan Choi
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sinal Patel
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Rohinton J. Morris
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - John W. Entwistle
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - H. Todd Massey
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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Goodwin ML, Mokadam NA. Total Artificial Heart Implantation: How I Teach It. Ann Thorac Surg 2019; 108:1271-1276. [PMID: 31520634 DOI: 10.1016/j.athoracsur.2019.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/01/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Matthew L Goodwin
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nahush A Mokadam
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Yaung J, Arabia FA, Nurok M. Perioperative Care of the Patient With the Total Artificial Heart. Anesth Analg 2017; 124:1412-1422. [PMID: 28107271 DOI: 10.1213/ane.0000000000001851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Advanced heart failure continues to be a leading cause of morbidity and mortality despite improvements in pharmacologic therapy. High demand for cardiac transplantation and shortage of donor organs have led to an increase in the utilization of mechanical circulatory support devices. The total artificial heart is an effective biventricular assist device that may be used as a bridge to transplant and that is being studied for destination therapy. This review discusses the history, indications, and perioperative management of the total artificial heart with emphasis on the postoperative concerns.
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Affiliation(s)
- Jill Yaung
- From the *Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California; and †Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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