Home Discharge and Out-of-Hospital Follow-Up of Total Artificial Heart Patients Supported by a Portable Driver

Purpose To enhance ambulation and facilitate hospital discharge of TAH-supported patients we adapted a mobile ventricular assistance device (VAD) driver (ExcorTM) for TAH use and report on the performance of ExcorTM– driven TAH patients discharged home. Methods and Materials Ten patients stabilized on a TAH, driven by the CSS, were progressively switched over to the ExcorTM in hospital over 14 days as a pilot, with daily hemodynamics and lab parameters measured. Twenty-two stable TAH patients were subsequently placed on the ExcorTM, trained and discharged home. Clinical and hemodynamic parameters were followed. Results All pilot study patients were clinically stable on the ExcorTM, with no decrease in TAH output noted (6.3 + 0.3 L/min (day 1) vs. 5.8 + 0.2 L/min (day 14), p=0.174, with a trend suggesting improvement of both hepatic and renal function. Twenty-two TAH patients were subsequently successfully discharged home on the portable driver and were supported out-of-hospital for up to 598 days (range 2–598, mean = 179 + 140 days), remaining ambulatory, NYHA Class I or II, and free of readmission for 88.5% of the time of support. Conclusions TAH patients may be effectively and safely supported by a mobile drive system. As such, the utility of the TAH may be extended to support patients beyond the hospital, at home, with overall ambulatory freedom.