Insertion of Total Artificial Heart

Insertion of total artificial heart is a type of surgery in which a total artificial heart (TAH) is a pump that is surgically installed in place of heart ventricles that are diseased or damaged to provide blood circulation.

Some facts about Insertion of Total Artificial Heart:

• The total artificial heart (TAH) is a form of mechanical circulatory support that can provide an additional option for patients requiring heart transplant as they can be implanted for the purpose of bridging to transplantation or being used for destination therapy.
• Insertion of total artificial heart is an option when there is a shortage of donor hearts.
• TAH is approved to be used in end stage biventricular heart failure as a bridge to heart transplantation.
• The use of mechanical circulatory support, including the TAH is growing exponentially as the number of patients with end-stage heart failure awaiting heart transplantation is exceeding the number of available donor hearts.
• A TAH is recommended if you have heart failure caused by ventricles that no longer pump blood well enough, and a long term support is required for you.
• It is an alternative treatment for patients who are unable to receive a heart transplant.
• Serious complications such as blood clots or infection can be a risk of TAH surgery.

Working of Total Artificial Heart:

• The lower chambers of the heart, called ventricles can be replaced by a TAH.
• TAH will be connected by the tubes to a power source that is outside the body.
• The TAH then pumps blood through the major artery of heart to the lungs and the rest of the body.
• The TAH has four mechanical valves that works in the similar way as the own valves of the heart to control blood flow.
• The upper chambers of the heart, called the atrium, the major arteries, the pulmonary artery, and the aorta is connected to the TAH by these valves.
• The TAH duplicates the working of a normal heart by providing mechanical circulatory support and restoring normal blood flow through the body once the it is connected.
• A bedside console can be used to power and control the TAH for patients in the hospital. People with a TAH use a portable control device after leaving the hospital. The portable control device fits in a shoulder bag or backpack that can be recharged at home or in a car and weighs about 14 pounds.

Necessity of Total Artificial Heart:

• TAH is required in case you have heart failure caused by ventricles that no longer pump blood well enough, and other treatments have not worked.
• TAH can help prolong your life if you are waiting for a heart transplant.
• TAH device is approved as a bridge to a transplant by the Federal Drug Administration (FDA).
• You are eligible for a TAH if you have heart failure and both of your ventricles are working poorly.
• A TAH should not be used if you are small as the device is too large to fit in the chests of children and some adults.
• The surgery is not required if you can benefit from other treatments, including medicines.
• Treatment with a ventricular assist device may be more appropriate if you have heart failure on only one side of your heart.
• You are not eligible for TAH if you cannot take anticlotting medicines as these medicines are required as long as the TAH is in place.

Preparation of Insertion of Total Artificial Heart:

• You need to spend at least a week in the hospital to prepare for the TAH surgery.
• During this time, you will continue to take any heart medicines given by your doctor and will learn about the TAH that you are getting and how to live with it.
• You may need to get extra nutrition through a feeding tube to make your body is strong enough for the surgery.
• Some blood tests, CT scan of your chest, MRI and X-Ray of chest, Electrocardiogram, Echocardiogram and Pulmonary function tests are done before the surgery to ensure your health condition.

Procedure of Insertion of Total Artificial Heart:

• The procedure involves for insertion of Total Artificial Heart is complex and can take five to nine hours.
• The surgical team include surgeon, Surgical nurses, Anesthesiologists, Perfusionists and Engineers.
• Local anesthesia will be given by an anesthesiologist to make you sleep before the surgery. The anesthesiologist will check your heart rate, blood pressure, oxygen levels, and breathing during the surgery.
• A breathing tube will be placed in your windpipe through your mouth which is connected to a ventilator machine to support your breathing during the surgery.
• Medicines are used to stop your heart so that the surgeons can operate on your heart while it is not moving.
• Oxygen-rich blood will keep moving through your body during the surgery through a heart-lung bypass machine.
• Your surgeons will cut into your chest bone to perform the surgery.
• After cutting the chest bone, your ribcage will be opened, ventricles of your heart will be removed , and the TAH will be attached to the upper chambers of your heart and to the aorta and the pulmonary artery.  
• The heart-lung bypass machine will be switched off when everything is attached and the TAH will be activated  by the surgical team to start pumping.
• The surgeon will close your chest again i the TAH is working properly and you are not bleeding abnormally. The chest will remain partially closed for a few days in some cases. It will fully be closed once additional tests confirm that everything is working as it should.

Recovery from Insertion of Total Artificial Heart:

• The duration to stay in hospital after surgery can be a month or more and the recovery time will depend on your health condition before the surgery.
• You will be moved to the intensive care unit right after surgery.
• Fluids and medications will be given through intravenous (IV) lines.
• Urine from your bladder and fluid and blood from your chest can be drained by other tubes.
• Oxygen can be given through a mask or nasal prongs in your nose.
• Your condition will be monitored and the signs of infection in your incision sites will be watched by your treatment team.
• The pain you have after surgery can be managed by your treatment team.
• Blood tests as well as chest imaging tests, including CT scans, x rays, and echocardiograms (ECG or EKG) will be performed.
• Electrocardiograms, heart monitors, and procedures such as cardiopulmonary resuscitation will no longer be useful as most of the heart has been removed.
• Your feeding, IV, and urine tubes will be removed by your healthcare team once you become stronger.