Internet video of the week : Surgical implantation of the CardioWest Total Artificial Heart

The CardioWest Total Artificial Heart (CW-TAH) is a pneumatically driven pump that completely replaces the patient’s native ventricles orthotopically. The device weighs 160 g and consists of two artificial ventricles, four Medtronic Hall tilting disk valves, two membranes, and two drivelines tunneled through the skin, which connect the ventricles to an external console generating pulsatile flow (1). At maximum stroke volume (close to 70 mL), it delivers a cardiac output between seven and nine litres per minute. Variations in cardiac output are determined by variations in venous return and peripheral resistance linked to the patient’s position and level of physical activity (2). The CW-TAH is indicated for use in patients with refractory cardiac failure as a bridge to transplantation, and when used for this indication, improves survival to transplant (3). Portable drivers have been approved in both Europe and the United States to allow stable patients to be discharged home while awaiting their transplant (4).

1. Slepian MJ, Smith RG, Copeland JG. The Syncardia CardioWest Total Artificial Heart. In: Baughman KL, Baumgartner WA. eds. Treatment of Advanced Heart Disease. New York, NY: Taylor and Francis Group, 2006:473.
2. Bellotto F, Compostella L, Agostoni P, et al. Peripheral adaptation mechanisms in physical training and cardiac rehabilitation: the case of a patient supported by a CardioWest total artificial heart. J Card Fail 2011;17:670-5. [PubMed]
3. Copeland JG, Smith RG, Arabia FA, et al. Cardiac replacement with a total artificial heart as a bridge to transplantation. N Engl J Med 2004;351:859-67. [PubMed]
4. Jaroszewski DE, Anderson EM, Pierce CN, et al. The SynCardia freedom driver: a portable driver for discharge home with the total artificial heart. J Heart Lung Transplant 2011;30:844-5. [PubMed]