Episode 231: Total Artificial Heart with Mike Essandoh

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 231: Total Artificial Heart with Mike Essandoh
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In this 231st episode I welcome Dr. Mike Essandoh back to the show to discuss the Total Artificial Heart. We discuss what it is, how it works, how it is put in, who is a good candidate, and how to manage people with TAHs from an anesthetic perspective when they come in for non-cardiac surgery.

CME: Link

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References:

  1. Yaung J, Arabia FA, Nurok M. Perioperative care of the patient with the total artificial heart. Anesthesia & Analgesia. 2017;124(5):1412-1422.
  2. Copeland J, Langford S, Giampietro J, Arancio J, Arabia F. Total Artificial Heart Update. Surgical Technology International. 2021;39.
  3. Rangwala Z, Banks DA, Copeland JG. Pro: the total artificial heart: is it an appropriate replacement for existing biventricular assist devices? Journal of cardiothoracic and vascular anesthesia. 2014;28(3):836-839
  4. Mizuguchi KA, Padera Jr RF, Kowalczyk A, Doran MN, Couper GS, Fox AA. Transesophageal echocardiography imaging of the total artificial heart. Anesthesia & Analgesia. 2013;117(4):780-784

2 Replies to “Episode 231: Total Artificial Heart with Mike Essandoh”

  1. Amazing podcast!

    Perhaps Dr. Essandoh can comment on the role (if any) of pulmonary vasodilators during TAH implantation? And also because pulmonary artery catheters are absolutely contraindicated, how does one evaluate the efficacy of pulmonary vasodilator therapies?

    Thank you!

    1. Great question Dr. Freiberg! Per Dr. Essandoh:

      So pre-TAH, right heart catheterization with a pulmonary artery catheter can be performed to quantify pulmonary artery pressures and pulmonary vascular resistance, and whether they are fixed or reversible. However, post-TAH, you have no ability to measure pulmonary arterial pressures via catheterization, because any structure traversing the mechanical valves will occlude the valves, and cause acute, irreversible, TAH failure. Since all TAH recipients are being bridged to heart transplantation, their pulmonary vascular resistances before TAH implantation should be reversible, and less than 4 Woods unit, to prevent failure of the transplanted heart.

      Concerning pulmonary vasodilators, most TAH recipients receive this therapy to support the failing right ventricle pre-TAH implantation. However, post-TAH implantation, if the TAH-right ventricular stroke volumes are normal, and proportional to the left ventricular stroke volumes, then it can be assumed that the pulmonary vascular resistance is within normal limits. However, if the TAH-RV stroke volume is low, despite normal fill volumes, and the TAH-LV fill volume and stroke volumes are low, then there is a likelihood for high pulmonary vascular resistance, and selective pulmonary vasodilator therapy may be instituted to facilitate trans-pulmonary blood flow.

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