Outcomes after heart transplantation and total artificial heart implantation: A multicenter study

Abstract BACKGROUND We sought to assess the outcomes after heart transplantation (HT) of patients supported with a temporary total artificial heart (t-TAH) as bridge to transplant in high-volume centers. METHODS A retrospective analysis of 217 consecutive patients who underwent t-TAH (SynCardia Systems, LLC, Tucson, Arizona) implantation between January 2014 and May 2019 in 6 high-volume North American centers was performed. End-points included survival and adverse events after t-TAH and HT. RESULTS The mean age of patients was 49±12 years and heart failure etiologies were non-ischemic dilated cardiomyopathy (36%), ischemic (25%) restrictive (12%) and cardiac graft failure (9%). One hundred and one (48%) patients had INTERMACS patient profile 1 (IPP-1) and 65 (31%) had IPP-2. At the end of the study period, 138/217 (63.5%) patients had undergone HT, 75/217 (34.5%) died before HT. Mean time between t-TAH implantation and HT averaged 181±179 days (range 0–849) and the mean follow-up after HT was 35±25 months. The overall survival in the entire cohort was 63%, 54% and 48% at 1, 2 and 5 years. Post-transplant survival was 88%, 84%, 79% and 74% at 6 months, 1 year, 2 years and 5 years respectively. Among the 32 patients (23%) who died after HT, the main causes of death were chronic allograft vasculopathy (25%), multi-organ failure (21.8%), sepsis (15.6%), and stroke (9%). CONCLUSION In this multicenter study, almost two third of patients implanted with a t-TAH could be transplanted. The overall and post-transplantation survival after t-TAH was satisfactory in these critically ill patients.