Implantation Strategies to Protect the Total Artificial Heart for Subsequent Heart Transplantation

Kai Ihnken; Francisco Arabia

doi:doi:10.11648/j.ijcts.20210705.12

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Implantation Strategies to Protect the Total Artificial Heart for Subsequent Heart Transplantation

Kai Ihnken, Francisco Arabia

Published in International Journal of Cardiovascular and Thoracic Surgery (Volume 7, Issue 5)

Received: 29 August 2021 Accepted: 26 September 2021 Published: 12 October 2021

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Abstract

Re-entry into the chest after one or more previous operative interventions can result in prolonged dissection, blood loss, structural damage, and catastrophic injuries, resulting in MOF and even death. Previous implantation of mechanical circulatory assist devices may lead to development of dense adhesions and solid scar tissue. This is certainly true for cases involving previous placement of the total artificial heart (TAH). Implantation of this device is on the rise, as is it is the only viable options for patients with biventricular failure, as the number of heart transplantations is stagnant worldwide. With the new heart transplantation allocation system in the United States, more and more patients with an implanted TAH are waiting for cardiac transplantation. Therefore, patients having an implanted TAH presenting for transplantation are at risk for complications during sternal re-entry or for complications as a result of prolonged ischemic time due to extended times of mediastinal dissection. Thoughtful and preemptive preparation of the surgical field at the time of initial implantation of the TAH has not only the potential, but a proven track record of decreasing operative time, duration of mediastinal dissection as well as risks for complications and adverse events in patients with subsequent heart transplantation. In conclusion, the measures for TAH protection taken at the time of implantation allow for expeditious and safe redo sternotomy, efficient mediastinal dissection, rapid identification and exposure of structures necessary for initiation of cardiopulmonary bypass and finally and importantly expeditious device removal in order to avoid delay in donor organ implantation and prolonged ischemic time.

Published in	International Journal of Cardiovascular and Thoracic Surgery (Volume 7, Issue 5)
DOI	10.11648/j.ijcts.20210705.12
Page(s)	55-58
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Total Artificial Heart, Redo Sternotomy, Heart Transplantation

References

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[2]	Khosbin E, Schueler S. Pre-transplant ventricular assist device explant. Ann Cardiothorac Surg 2018; 7 (1): 160-168.
[3]	Ihnken K, Ramzy D, Esmailian F, Trento A, Arabia F. Surgical technique to facilitate explantation of mechanical circulatory support devices: LVADs, BiVADs, and TAHs before heart transplantation. ASAIO Journal 2016; 62: 211-213.
[4]	Copeland Jm, Smith R, Arabia F, Nolan, P, Banchy M. The CardioWest total artificial heart as a bridge to transplantation. Sem Thorac Cardiovasc Surg 200012 (3): 238-242.
[5]	Copeland JG, Arabia FA, Smith RG, Covington D: Synthetic membrane neo-pericardium facilitates total artificial heart explantation. J Heart Lung Transplant 20: 654–656, 2001.
[6]	Walther T, Rastan A, Daehnert I, Falk F, Jacobs S, Mohr F, Kostelka M. A novel adhesion barrier facilitates reoperations in complex congenital cardiac surgery. The J of Thorac and Cardiovac Surg 2005; 129 (2): 359-363.
[7]	Arabia F, Copeland J, Pavie A, Smith R. Implantation technique for the Cardio Wesr total artificial heart. Ann Thorac Surg 1999; 68: 698-704.
[8]	Jaroszewski D, Lackey J, Lanza L, DeValeria P, Arabia F. Use of an inexpensive blue band during ventricular assist device and total artificial heart placement facilitates. And expedites explantation during heart transplant. Ann Thorac Surg 2009; 87: 1623-4.
[9]	Hamid U, Digney R, Soo L, Leung S, Graham A. Incidence and outcome of re-entry injury in redo cardiac surgery: benefits of preoperative planning. Eur J Cardiovasc Surg 2015; 47: 819-823.
[10]	Arabia FA, Copeland JG, Larson DF, Smith RG, Cleavinger MR: Circulatory assist devices: applications for ventricular recovery or bridge to transplant, in: Gravlee PG, Davis FG, Utley JR (eds). Cardiopulmonary Bypass: Principles and Practice. Baltimore, MD: Williams & Wilkins, 1993, pp. 693–712.
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[15]	Iliopoulos J, Cornwall G, Evans R, Manganas C, Thomas K, Newman D, Walsh W. Evaluation of a bioabsorbable polylactide film in a large animal model for the reduction of retrosternal adhesions. J of Surgical Research 2003; 118: 144-153.
[16]	Chen Z, Zheng J, Zhang J, Li S. A novel bioabsorbable pericardial membrane substitute to reduce postoperative pericardial adhesions in a rabbit model. Interactive Cardiovasc and Thorac Surg 2015; 21: 565-72.
[17]	Leprince P, Rahmati M, Bors V, Rama A, Leger P, Gandjbakhch I, Pavie A. Expanded polytetrafluoroethylene membranes to wrap surfaces of circulatory support devices in patientrs undergoing bridge to heart transplantation. Eur J Cardio-thorac Surg 2001; 19: 302-6.
[18]	Amato JJ, Cotroneo JV, Galdieri RJ, et al. Experience with the polytetrafluoroethylene surgical membrane for pericardial closure in operations for congenital cardiac defects. J Thorac Cardiovasc Surg 1989; 97: 929-34.
[19]	Koul B, Solem J, Steen S, et al. Heartmate left ventricular assist device as bridge to heart transplantation. Ann Thorac Surg 65: 1625–1623, 1998.

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APA Style

Kai Ihnken, Francisco Arabia. (2021). Implantation Strategies to Protect the Total Artificial Heart for Subsequent Heart Transplantation. International Journal of Cardiovascular and Thoracic Surgery, 7(5), 55-58. https://doi.org/10.11648/j.ijcts.20210705.12

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ACS Style

Kai Ihnken; Francisco Arabia. Implantation Strategies to Protect the Total Artificial Heart for Subsequent Heart Transplantation. Int. J. Cardiovasc. Thorac. Surg. 2021, 7(5), 55-58. doi: 10.11648/j.ijcts.20210705.12

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AMA Style

Kai Ihnken, Francisco Arabia. Implantation Strategies to Protect the Total Artificial Heart for Subsequent Heart Transplantation. Int J Cardiovasc Thorac Surg. 2021;7(5):55-58. doi: 10.11648/j.ijcts.20210705.12

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@article{10.11648/j.ijcts.20210705.12,
  author = {Kai Ihnken and Francisco Arabia},
  title = {Implantation Strategies to Protect the Total Artificial Heart for Subsequent Heart Transplantation},
  journal = {International Journal of Cardiovascular and Thoracic Surgery},
  volume = {7},
  number = {5},
  pages = {55-58},
  doi = {10.11648/j.ijcts.20210705.12},
  url = {https://doi.org/10.11648/j.ijcts.20210705.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20210705.12},
  abstract = {Re-entry into the chest after one or more previous operative interventions can result in prolonged dissection, blood loss, structural damage, and catastrophic injuries, resulting in MOF and even death. Previous implantation of mechanical circulatory assist devices may lead to development of dense adhesions and solid scar tissue. This is certainly true for cases involving previous placement of the total artificial heart (TAH). Implantation of this device is on the rise, as is it is the only viable options for patients with biventricular failure, as the number of heart transplantations is stagnant worldwide. With the new heart transplantation allocation system in the United States, more and more patients with an implanted TAH are waiting for cardiac transplantation. Therefore, patients having an implanted TAH presenting for transplantation are at risk for complications during sternal re-entry or for complications as a result of prolonged ischemic time due to extended times of mediastinal dissection. Thoughtful and preemptive preparation of the surgical field at the time of initial implantation of the TAH has not only the potential, but a proven track record of decreasing operative time, duration of mediastinal dissection as well as risks for complications and adverse events in patients with subsequent heart transplantation. In conclusion, the measures for TAH protection taken at the time of implantation allow for expeditious and safe redo sternotomy, efficient mediastinal dissection, rapid identification and exposure of structures necessary for initiation of cardiopulmonary bypass and finally and importantly expeditious device removal in order to avoid delay in donor organ implantation and prolonged ischemic time.},
 year = {2021}
}

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TY  - JOUR
T1  - Implantation Strategies to Protect the Total Artificial Heart for Subsequent Heart Transplantation
AU  - Kai Ihnken
AU  - Francisco Arabia
Y1  - 2021/10/12
PY  - 2021
N1  - https://doi.org/10.11648/j.ijcts.20210705.12
DO  - 10.11648/j.ijcts.20210705.12
T2  - International Journal of Cardiovascular and Thoracic Surgery
JF  - International Journal of Cardiovascular and Thoracic Surgery
JO  - International Journal of Cardiovascular and Thoracic Surgery
SP  - 55
EP  - 58
PB  - Science Publishing Group
SN  - 2575-4882
UR  - https://doi.org/10.11648/j.ijcts.20210705.12
AB  - Re-entry into the chest after one or more previous operative interventions can result in prolonged dissection, blood loss, structural damage, and catastrophic injuries, resulting in MOF and even death. Previous implantation of mechanical circulatory assist devices may lead to development of dense adhesions and solid scar tissue. This is certainly true for cases involving previous placement of the total artificial heart (TAH). Implantation of this device is on the rise, as is it is the only viable options for patients with biventricular failure, as the number of heart transplantations is stagnant worldwide. With the new heart transplantation allocation system in the United States, more and more patients with an implanted TAH are waiting for cardiac transplantation. Therefore, patients having an implanted TAH presenting for transplantation are at risk for complications during sternal re-entry or for complications as a result of prolonged ischemic time due to extended times of mediastinal dissection. Thoughtful and preemptive preparation of the surgical field at the time of initial implantation of the TAH has not only the potential, but a proven track record of decreasing operative time, duration of mediastinal dissection as well as risks for complications and adverse events in patients with subsequent heart transplantation. In conclusion, the measures for TAH protection taken at the time of implantation allow for expeditious and safe redo sternotomy, efficient mediastinal dissection, rapid identification and exposure of structures necessary for initiation of cardiopulmonary bypass and finally and importantly expeditious device removal in order to avoid delay in donor organ implantation and prolonged ischemic time.
VL  - 7
IS  - 5
ER  -

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Author Information

Kai Ihnken

Department of Surgery, Division of Cardiothoracic Surgery, University of California, San Francisco, the United States
Francisco Arabia

Department of Surgery, Division of Cardiothoracic Surgery, University of Arizona, Phoenix, the United States

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Plain Text BibTeX RIS

APA Style

Kai Ihnken, Francisco Arabia. (2021). Implantation Strategies to Protect the Total Artificial Heart for Subsequent Heart Transplantation. International Journal of Cardiovascular and Thoracic Surgery, 7(5), 55-58. https://doi.org/10.11648/j.ijcts.20210705.12

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ACS Style

Kai Ihnken; Francisco Arabia. Implantation Strategies to Protect the Total Artificial Heart for Subsequent Heart Transplantation. Int. J. Cardiovasc. Thorac. Surg. 2021, 7(5), 55-58. doi: 10.11648/j.ijcts.20210705.12

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AMA Style

Kai Ihnken, Francisco Arabia. Implantation Strategies to Protect the Total Artificial Heart for Subsequent Heart Transplantation. Int J Cardiovasc Thorac Surg. 2021;7(5):55-58. doi: 10.11648/j.ijcts.20210705.12

Copy | Download

@article{10.11648/j.ijcts.20210705.12,
  author = {Kai Ihnken and Francisco Arabia},
  title = {Implantation Strategies to Protect the Total Artificial Heart for Subsequent Heart Transplantation},
  journal = {International Journal of Cardiovascular and Thoracic Surgery},
  volume = {7},
  number = {5},
  pages = {55-58},
  doi = {10.11648/j.ijcts.20210705.12},
  url = {https://doi.org/10.11648/j.ijcts.20210705.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20210705.12},
  abstract = {Re-entry into the chest after one or more previous operative interventions can result in prolonged dissection, blood loss, structural damage, and catastrophic injuries, resulting in MOF and even death. Previous implantation of mechanical circulatory assist devices may lead to development of dense adhesions and solid scar tissue. This is certainly true for cases involving previous placement of the total artificial heart (TAH). Implantation of this device is on the rise, as is it is the only viable options for patients with biventricular failure, as the number of heart transplantations is stagnant worldwide. With the new heart transplantation allocation system in the United States, more and more patients with an implanted TAH are waiting for cardiac transplantation. Therefore, patients having an implanted TAH presenting for transplantation are at risk for complications during sternal re-entry or for complications as a result of prolonged ischemic time due to extended times of mediastinal dissection. Thoughtful and preemptive preparation of the surgical field at the time of initial implantation of the TAH has not only the potential, but a proven track record of decreasing operative time, duration of mediastinal dissection as well as risks for complications and adverse events in patients with subsequent heart transplantation. In conclusion, the measures for TAH protection taken at the time of implantation allow for expeditious and safe redo sternotomy, efficient mediastinal dissection, rapid identification and exposure of structures necessary for initiation of cardiopulmonary bypass and finally and importantly expeditious device removal in order to avoid delay in donor organ implantation and prolonged ischemic time.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - Implantation Strategies to Protect the Total Artificial Heart for Subsequent Heart Transplantation
AU  - Kai Ihnken
AU  - Francisco Arabia
Y1  - 2021/10/12
PY  - 2021
N1  - https://doi.org/10.11648/j.ijcts.20210705.12
DO  - 10.11648/j.ijcts.20210705.12
T2  - International Journal of Cardiovascular and Thoracic Surgery
JF  - International Journal of Cardiovascular and Thoracic Surgery
JO  - International Journal of Cardiovascular and Thoracic Surgery
SP  - 55
EP  - 58
PB  - Science Publishing Group
SN  - 2575-4882
UR  - https://doi.org/10.11648/j.ijcts.20210705.12
AB  - Re-entry into the chest after one or more previous operative interventions can result in prolonged dissection, blood loss, structural damage, and catastrophic injuries, resulting in MOF and even death. Previous implantation of mechanical circulatory assist devices may lead to development of dense adhesions and solid scar tissue. This is certainly true for cases involving previous placement of the total artificial heart (TAH). Implantation of this device is on the rise, as is it is the only viable options for patients with biventricular failure, as the number of heart transplantations is stagnant worldwide. With the new heart transplantation allocation system in the United States, more and more patients with an implanted TAH are waiting for cardiac transplantation. Therefore, patients having an implanted TAH presenting for transplantation are at risk for complications during sternal re-entry or for complications as a result of prolonged ischemic time due to extended times of mediastinal dissection. Thoughtful and preemptive preparation of the surgical field at the time of initial implantation of the TAH has not only the potential, but a proven track record of decreasing operative time, duration of mediastinal dissection as well as risks for complications and adverse events in patients with subsequent heart transplantation. In conclusion, the measures for TAH protection taken at the time of implantation allow for expeditious and safe redo sternotomy, efficient mediastinal dissection, rapid identification and exposure of structures necessary for initiation of cardiopulmonary bypass and finally and importantly expeditious device removal in order to avoid delay in donor organ implantation and prolonged ischemic time.
VL  - 7
IS  - 5
ER  -

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