• Circulation 04/2014; 129(14):1530-7. DOI:10.1161/CIRCULATIONAHA.113.005574 · 14.95 Impact Factor
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    ABSTRACT: Advances in medical therapies have yielded improvement in morbidity and a decrease in mortality for patients with congenital heart disease, both surgically palliated and uncorrected. An unintended consequence is a cohort of adolescent and adult patients with heart failure who require alternative therapies. One intriguing option is placement of a total artificial heart (TAH) either as a bridge to transplant or as a destination therapy. Of the 1091 Jarvik-7 type TAH (Symbion, CardioWest, and SynCardia) placed between 1985 and 2012, only 24 have been performed in patients with congenital heart disease, and a total of 51 were placed in patients younger than 21 years of age. At our institution, the SynCardia TAH was implanted in a 19-year-old patient with cardiac allograft failure due to chronic rejection and related multisystem organ failure including need for hemodialysis. Over the next year, she was nutritionally and physically rehabilitated, as were her end organs, allowing her to come off dialysis, achieve normal renal function, and eventually be successfully transplanted. Given the continued growth of adolescent and adult congenital heart disease populations with end-stage heart failure, the TAH may offer therapeutic options where previously there were few. Additionally, smaller devices such as the SynCardia 50/50 will open the door for applications in smaller children. The Freedom Driver offers the chance for patients to leave the hospital with a TAH, as does the AbioCor which is a fully implantable TAH option. In the current report, we review the history of the TAH and potential applications in adolescent patients and congenital heart disease.
    ASAIO journal (American Society for Artificial Internal Organs: 1992) 09/2014; 61(1). DOI:10.1097/MAT.0000000000000156 · 1.39 Impact Factor
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    ABSTRACT: The decreased trend in mortality after congenital heart surgery has resulted in a growing population of adults with congenital heart disease. Admissions for all types of adults with congenital heart disease have increased especially those in heart failure and in particular those with a failing Fontan circulation. These patients are the fastest growing cohort of heart failure patients currently presenting to congenital heart centers. Treatment options for these patients include Fontan conversion, ventricular assist devices, heart transplantation, and/or total artificial heart implantation. The use of virtual surgery software has improved our ability to offer a variety of mechanical devices to small adults with congenital heart disease and those with complex congenital anatomy for whom in the past certain devices were thought not to be an option. As device technology improves, we hopefully will be able to address this wave of young and middle aged adults with congenital heart disease and heart failure.
    Progress in Pediatric Cardiology 12/2014; 38(1-2):33-35. DOI:10.1016/j.ppedcard.2014.12.006


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May 30, 2014