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Total Artificial Heart Provides Time For Those Waiting For A Transplant

Yoshifumi Naka, MD, PhD

Yoshifumi Naka, MD, PhD

Total Artificial Heart Improves Patient Survival to Transplant While Reducing Some Risks of Transplant Surgery

Surgeons at NewYork-Presbyterian Hospital/Columbia University Medical Center performed the first Total Artificial Heart implant in the New York City area to replace a patient’s dying heart.

“For patients who will die without a heart transplant, the Total Artificial Heart helps them survive until they can get one. By replacing the heart, we are eliminating the symptoms and the source of heart failure,” said lead surgeon Dr. Yoshifumi Naka, director of Cardiac Transplantation and Mechanical Circulatory Support Programs at New York-Presbyterian/Columbia and associate professor of surgery at Columbia University College of Physicians and Surgeons.

Similar to a heart transplant, the SynCardia temporary Total Artificial Heart replaces both failing heart ventricles and all four heart valves. Once implanted, the Total Artificial Heart provides immediate blood flow of up to 9.5 liters per minute. This high volume of blood flow helps speed the recovery of vital organs, including the brain, liver, kidneys, and GI tract, helping make the patient a better transplant candidate.

Animation: SynCardia’s Total Artificial Heart Beating in Chest

During the surgery, Dr. Naka and his team remove the patient’s heart; sew “quick connects” into the atria, aorta and pulmonary artery; then attach the Total Artificial Heart. According to surgeons, the Total Artificial Heart makes the subsequent transplant less demanding because the patient’s heart has already been removed and the device is easily detached via the quick connects, thus reducing risk for surgical bleeding.

“The artificial heart does more than improve a patient’s chances of surviving to transplant. It reduces some of the risks of the transplant surgery itself. When we implant the device, we are already preparing for transplant,” says Dr. Naka.

For patients who have already had a heart transplant and are rejecting their donor heart, there is another advantage to using the Total Artificial Heart: Since their donor heart is removed, they can be taken off immunosuppressive drugs, reducing risk for infections and other side effects such as kidney failure.

Despite increased demand, there are only approximately 2,000 donor hearts available annually in the United States. It is estimated that each year, as many as 100,000 people in the U.S. alone could benefit from mechanical circulatory support devices.

The Total Artificial Heart, manufactured by SynCardia Systems Inc., was first introduced in the mid-1980s, and more than 950 patients have been implanted with the device since. A 10-year clinical study led by the University of Arizona, Tucson, and published in the Aug. 2004 New England Journal of Medicine showed that 79 percent of patients receiving the Total Artificial Heart survived to transplant, representing the highest bridge-to-transplant rate for a heart device. Later that year, the device received FDA approval.

Artificial hearts represent the next stage in the evolution from left ventricular heart assist devices (LVADs), introduced in the 1990s, and biventricular assist devices (BiVADs), introduced in the 2000s.

NewYork-Presbyterian/Columbia performs more than 1,600 open-heart procedures annually, including a nation-leading 84 heart transplants in 2010. U.S.News & World Report has ranked NewYork-Presbyterian/Columbia in the top 10 for Cardiology & Heart Surgery among “America’s Best Hospitals” for eight years running. The Hospital has more than 30 years of experience in caring for cardiac transplant patients and developing new treatments that extend their lives.

*This blog post was originally published at Columbia University Department of Surgery Blog*

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