Enhanced Ambulation and Discharge from the Hospital with a Total Artificial Heart

来源 :2011第三届心脏病学大会 | 被引量 : 0次 | 上传用户:liuxin87675241
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  Background:The Total Artificial Heart (TAH), manufactured by SynCardia Systems, is an effective means for immediate hemodynamic restoration of failing patients with end-dstage bi-dventricular heart failure.It has been demonstrated that failing patients (NYHA Class Ⅳ, Intermacs Level Ⅰ) rapidly recover on the TAH, become increasingly capable of ambulation, returning to NYHA Class Ⅰ or Ⅱ while awaiting transplantation.TAH patients today remain limited in mobility due to the reliance on a large pneumatic drive console (CSS.) I report the first clinical study examining the ability of TAH patients to increase ambulation and be discharged home using a mobile drive system (modified Excor driver).Methods: Pilot Study: Ten TAH patient volunteers, stable on the CSS hospital driver, were progressively transitioned over a four-day period to the modified mobile driver.Hemodynamics, lab data and ambulation (events and length of excursion) were obtained, and results at 14 d compared to baseline on the CSS.Discharge Study: 22 stable TAH patients (14 plus 8 from pilot study) were ten trained and successfully discharged from the hospital.Survival, transplantation rate, percent of time free of readmission, and activity level were determined.Results: Pilot Study: Mean aortic pressure (mmHg) on the portable driver was similar over 14 d with a minor decline vs.baseline, 92 ± 4 vs.98 ± 6, p=0.02.No reduction in Hct, Renal or hepatic function was seen, with frank improvement in renal function noted.LDH (hemolysis) declined while on the Excor (596 ± 170 vs.850 ± 46, p=0.047).Ambulation increased 5 ± 2 vs.2 ± 1 trips/day, 1000 ± 180 vs.3600 ± 1000 feet/d.on the portable driver.Discharge Study: 17/22 patients remain alive, discharged from the hospital on the mobile driver.10/22 have been successfully transplanted.The 22 patients have been supported for 3938 patient days, with 87% of this time beings pent out of the hospital.All discharged patients have remained freely selfambulatory, with six driving an auto, four returning to work and eight resuming sexual activity.Conclusion: Utilizing a portable pneumatic driver, stable TAH patients were able to increase their mobility, enhance their extent of ambulation and be successfully trained and discharged from the hospital to function at home, largely free of readmission.
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