Abstract 14122: Total Artificial Heart Fit Study: Using 3-Dimensional Computer Simulation to Perform Virtual Implantation of the Total Artificial Heart in Adolescents and Young Adults to Ensure Spatial Suitability
Introduction: The Syncardia temporary Total Artificial Heart (TAH-t) replaces a patient’s failing ventricles as a “bridge-to-transplant.” The TAH-t is contraindicated if insufficient space exists in the chest after removal of the native ventricles. Proper fit of the 70/70cc TAH-t entails a body surface area (BSA) > 1.7m2 or a distance between the sternum and 10th thoracic vertebra (T10) > 10cm by computed tomography (CT). The fit of the device is a key factor for eligibility in adolescents and young adults.
Hypothesis: We assess the hypothesis that 3D computer simulation of TAH-t implantation detects safe placement in smaller patients and those with multiple surgical palliations despite standard fit criteria.
Methods: Four patients (age 12-34 yrs; BSA 1.3-1.9m2) eligible for cardiac transplant underwent TAH-t 3D fit simulation. The 70/70cc TAH-t was scanned by CT and 3D reconstruction was performed using Mimics software (Materialise, Belgium). The patient’s chest CT was segmented into bones, lungs, heart and vessels using Mimics. The ventricles were removed and the TAH-t was attached to the atrioventricular valve annulus as per the actual procedure. The device was evaluated for fit within the chest and possible compression of adjacent structures (see image).
Results: The device successfully fit two patients by 3D simulation despite one patient measuring < 10cm from sternum to T10 by CT. Those two patients underwent successful TAH-t placement (age 19 and 34 yrs; BSA 1.7 and 1.9m2, respectively). Post-device chest CT showed no compression of pertinent anatomic structures as predicted by the pre-device simulation. Device placement was not performed in the other two patients due to poor fit by 3D simulation.
Conclusion: In conclusion, TAH-t 3D fit simulation allows for safer selection of patients and can detect spatial complications prior to insertion. With the introduction of the new 50/50cc TAH-t, pediatric eligibility will require similar rigorous 3D simulation.
- Artificial heart/Cardiac support devices
- Cardiac imaging
- Heart failure
- Congenital heart disease
- Ventricular assist devices
- © 2013 by American Heart Association, Inc.