We have developed a new method of total artificial heart (TAH) support for young patients,
and here share our preliminary results and evolving understanding.
This report is a retrospective chart review of all patients <10 kg who received a
TAH at our institution from May 2017 to the time of this report.
Our cohort includes 5 patients. Two had single-ventricle circulation, 1 of whom had
undergone a Glenn procedure and was revised back to a Sano shunt. Four were on extracorporeal
life support for longer than 10 days, 3 with an open chest. In these 3 patients, the
TAH was a salvage operation. Centrifugal pumps were used for 2 patients and pulsatile
pumps for 3 patients. Three patients survived to transplantation and discharge, with
support times of 79, 44, and 96 days; in these patients, the duration of follow-up
from discharge to the time of this report was 687, 19, and 8 days, respectively, and
all patients were well. For the pulsatile pumps, in the first patient we placed valved
conduits for inflow connections. For the second patient, we omitted the valved conduits
and oversized the pumps to avoid full fill; yet, despite our best efforts, full fill
occurred frequently, and thus we converted to a systemic centrifugal pump.
Our method of TAH support can be tailored to provide effective support of carefully
selected young children with single or biventricular physiology. In our opinion, for
pulsatile pumps, oversizing the pump and using valved inflow conduits may be important
adjuncts to achieve effective support.