Worldwide Use of SynCardia Total Artificial Heart in Adolescents: A 25-Year Experience
D.L. Morales, F. Zafar, A. Lorts, T.D. Ryan, C. Chin, J.A. Towbin, J.L. Jefferies. Heart Institute, Cincinnati Children's Hospital, University of Cincinnati School of Medicine, Cincinnati, OH
Purpose: Patients with biventricular failure and multiple systemic organ compromise are a challenging cohort, particularly adolescents with congenital heart disease. Many types of mechanical circulatory support have been used in an attempt to support these patients, including extracorporeal membrane oxygenation, biventricular assist devices, and total artificial hearts (TAH). Herein, the experience with the Syncardia TAH in this patient cohort over the past 25 years is analyzed to examine if results have changed over time.
Methods and Materials: All patients who had the SynCardia TAH implanted from 1986 to 2012 were identified in the Worldwide SynCardia TAH database, which contains 1091 patients as of November 13, 2012.
Results: TAH was implanted in 45 (4.1%) adolescents (age ≤20). It was implanted in 18 institutions around the world [US(11), EU(4), Canada(2) and Australia(1)] with 13 TAHs being the most implanted in a single institution. Median age of this group was 17 years (13-20) and 18%(8) were female. Etiologies of heart failure included cardiomyopathy 30(66.6%) [dilated 17, hypertrophic/restrictive 6, post-partum 2, ischemic 2, other 3]; congenital heart disease 6(13.3%); myocarditis 2; graft rejection 2, and others 5. Total support time was 2815 days with a mean time of 62 ± 110 days(1-605 days). Only 5(11%) patients required support over 6 months. Overall survival was 69%(31) over the entire time period. Over the last decade, survival is better, 75%(15/20), compared to initial experience 64%(16/25) but lacks statistical significance (p = 0.5). Mortality occurred in first 30 days in 79%(11/14); with 36%(5/14) of deaths occurring in the first 48 hours. Competing outcomes analysis at 2 mo demonstrates 71% of patients had a positive outcome: 29% were still on the TAH, 42% were transplanted, and 29% died.
Conclusions: Although a challenging cohort, the majority of critically ill adolescents were successfully supported with the SynCardia TAH. Notable is what appears to be improving outcomes with increasing experience.
Session: Concurrent Session 35: PEDS 2: Mechanical Circulatory Support in Children (4:00 PM-5:30 PM)
Date/Time: Friday, April 26, 2013 - 5:15 PM