Artificial Heart Transplant - Medical Experts

The term ‘artificial heart’ covers several mechanical support systems. Which system is suitable depends on which heart chamber requires assistance or whether the patient’s own heart needs to be completely replaced.

VAD stands for ventricular assist device, i.e. a support system for a heart ventricle. With an LVAD, the patient’s own heart remains in the body and continues to work alongside the pump.

This is how an LVAD differs from a heart transplant. In a transplant, the patient’s own heart is replaced by a donor organ, whilst the VAD system provides mechanical support for heart function.

The decision depends on the patient’s state of health, the function of both heart ventricles and the treatment objective.

In cases of advanced heart failure, the option of an LVAD or a heart transplant should be assessed in good time. This is crucial for the prognosis. A multidisciplinary team assesses whether such a support system is suitable.

The artificial heart supports blood flow when the patient’s own heart can no longer adequately maintain circulation. It is not possible to predict with certainty the level of physical capacity and quality of life that can be achieved for individual patients.

In the follow-up to an LVAD study, the estimated five-year survival rate with a magnetically levitated pump was around 58 per cent of those treated. With the older axial-flow pump, it was around 44 per cent in the same study.

The study data do not allow for a reliable prediction of an individual’s life expectancy. The prognosis depends, amongst other things, on how advanced the heart failure is and whether other organs are affected. The function of the right ventricle is also taken into account when selecting the system.

Before implantation, specialists in cardiology and anaesthesia, as well as cardiac surgeons, assess whether a permanent cardiac support system is medically appropriate. In doing so, they take into account the patient’s state of health and the planned form of circulatory support.

A key examination is the cardiac ultrasound. Doctors use this to assess the function of both ventricles. Particular attention is paid to the right ventricle, as it must continue to function adequately following the implantation of an LVAD.

As part of the preparation, the specialists determine the surgical procedure and the necessary circulatory monitoring. Whether an open or a less invasive technique is possible depends on the individual situation.

The exact surgical technique used to implant an artificial heart depends on the support system and the patient’s physical condition.

The procedure varies depending on the surgical technique:

1. In the open LVAD surgery examined, the patient is given a general anaesthetic.
2. A heart-lung machine was used in the open surgery examined.
3. A pulmonary artery catheter was used in this procedure to monitor circulation.
4. In a less invasive technique, the pump is inserted through a small incision on the left side of the chest.
5. The outflow tract is connected to the ascending aorta, the main vessel of the systemic circulation.
6. The less invasive procedure described can be performed without a heart-lung machine.

A hospital stay is required following the operation. In a Dutch study, the median total length of stay, including the days before and after the procedure, was around 41 days. In individual cases, the hospital stay may be significantly shorter or longer.

An artificial heart can cause serious complications. These include bleeding, infections at the external lead site, blood clots and technical problems.

In a study of the HeartMate 3 system, the following events were observed:

• Repeat surgery due to bleeding: this was required in around 16 out of every 100 patients treated.
• Ischaemic stroke: A stroke caused by a blocked blood vessel occurred in around 16 out of every 100 patients treated.
• Cerebral haemorrhage: Around 8 in 100 patients suffered a stroke caused by this.
• Right-sided heart failure: This complication affected around 14 in 100 patients.
• Clot in the outflow tract: This problem occurred in around 2 out of 100 patients treated.

In a randomised HeartMate 3 trial, omitting additional aspirin resulted in fewer non-surgical haemorrhages when a vitamin K antagonist was continued. This is an anticoagulant. Do not change this treatment on your own.

Following their hospital stay, patients require specialised long-term care. This involves monitoring the support system, circulatory function and any potential complications.

A cable runs through the skin to the outside of the body. Careful management of the exit site is essential to prevent infections. How the dressing is applied and the cable secured depends on the centre’s care protocol.

Depending on the protocol, the dressing is changed daily to weekly. No single standard has been shown to be clearly superior for securing the cable or the frequency of dressing changes. Patients should therefore follow the guidelines provided by the centre where the implant was performed.

Specialised long-term care is required following implantation.

The following questions are useful for the initial consultation:

• Which artificial heart is suitable for me, and is a temporary bridge part of my treatment plan?
• What surgical technique is planned for me?
• How will my family members be briefed on care at the discharge facility?
• Who can I contact after discharge if I have any technical or medical problems?

You will find specialists in artificial hearts at the end of this text.