Bridge for Transplantation with the Symbion and Cardiowest Total Artificial Heart: The Pitie Experience

Since April 1986, 92 patients have received a pneumatic total artificial heart, Jarvik-7: 62 a Symbion model, and 30 a Cardiowest model. The duration of support ranged from less than 1 day to 603 days (mean duration 23 ± 64). The indications were acute shock (41 cases) or chronic deterioration on the transplant waiting list (51 cases). The etiology was mainly idiopathic and ischemic cardiomyopathy. With the help of our scoring system, we divided our patients into three groups: (1) Chronic Implantation group, represented by two females staying on the device for 6 and 19 months, respectively; (2) a Rescue group of 35 patients characterized by high-risk indications: graft failure, rejection, postcardiotomy patient, postpartum cardiomyopathy, and reoperation for valvular and congenital conditions. In addition, the dilated and ischemic cardiomyopathy patients operated on in very bad condition with a score over 6 were included in this group; and (3) a Low Risk Indication group (55 patients) comprising mostly the dilated and ischemic cardiomyopathy patients with a score under 6. Due to the shortage of donors, our criteria for transplantation are very strict. Transplants should be carried out only in cases of hemodynamic stability, on an extubated patient with normal renal and liver function, without coagulation problems or infection. With such criteria, in the Rescue group, only seven patients could be transplanted and of these, three are still alive. In contrast, in the Low Risk group, 33 were transplanted (60%), and 70% of these patients were discharged. The rate has improved in the most recent cases, with 83% of the Cardiowest patients being survivors.