Interagency registry for mechanically assisted circulatory support report on the total artificial heart.
BACKGROUND We sought to better understand the patient population who receive a temporary total artificial heart (TAH) as bridge to transplant or as bridge to decision by evaluating data from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database. METHODS We examined data related to survival, adverse events, and competing outcomes from patients who received TAHs between June 2006 and April 2017 and used hazard function analysis to explore risk factors for mortality. RESULTS Data from 450 patients (87% men; mean age, 50 years) were available in the INTERMACS database. The 2 most common diagnoses were dilated cardiomyopathy (50% and ischemic cardiomyopathy (20% Risk factors for right heart failure were present in 82% of patients. Most patients were INTERMACS Profile 1 (43% or 2 (37% at implantation. There were 266 patients who eventually underwent transplantation, and 162 died. Overall 3 6 and 12 month actuarial survival rates were 73% 62% and 53% respectively. Risk factors for death included older age (p 0.001) need for pre implantation dialysis (p 0.006) higher creatinine (p 0.008) and lower albumin (p 0.001) levels, and implantation at a low volume center =10 TAHs; p 0.001) Competing outcomes analysis showed 71% of patients in high volume centers were alive on the device or had undergone transplantation at 12 months after TAH implantation vs 57% in low volume centers (p 0.003) CONCLUSIONS Patients receiving TAHs have rapidly declining cardiac function and require prompt intervention. Experienced centers have better outcomes, likely related to patient selection, timing of implantation, patient care, and device management. Organized transfer of knowledge to low volume centers could improve outcomes.
The Journal of heart and lung transplantation the official publication of the International Society for Heart Transplantation