Beginning last October, I spent three months following Baylor University Medical Center’s heart transplant program, which, in less than four years, established itself as one of the world’s busiest centers. In addition to heart transplants, its surgeons implanted left ventricular assist devices (LVADs) and performed a variety of open-heart surgeries. Its goal when it rebuilt its program in 2012—hiring away highly regarded surgeons from the Cleveland Clinic—was to provide the full service line of treatments for heart failure. And there was still one sea yet to cross: The total artificial heart, which Baylor’s surgeons have now successfully implanted in a patient. It kept him alive until a transplant was available.
This isn’t a particularly new phenomenon in heart surgery, but it’s also not common. Yet, for a sliver of patients, the device is their best chance for survival. The total artificial heart, or TAH, is for patients with failing right and left ventricles. The LVAD acts as if it is the left ventricle, pushing blood through the aorta to the rest of the body. But if the right ventricle was damaged, whether by a genetic disease or a heart attack or other less common abnormalities, the patient had few options, all of which required intensive treatment at a hospital. Now, Baylor University Medical Center’s surgeons have another tool to keep patients alive until a heart is available.
“The LVAD, which is implanted in the left side of the heart, needs a working right side. So when both are failing, it needs something that replaces both sides,” says Dr. Shelley Hall, the hospital’s chief of transplant cardiology and mechanical circulatory support. “It’s an acceptable, although limited, device used to bridge people to transplant.”
The total artificial heart connects a pair of tubes to the patient’s bottom chambers, known as the ventricles. Those are attached to a power source kept outside the patient’s body. Caregivers then program the machine to apply the necessary pressure to push the blood through the ventricles. After the patient recovers from surgery, they’re designated as 1A—the most severe need—on the transplant list while they’re in the hospital. They drop to 1B when they return home. Hall says they’re always activated within one to three months to avoid complications. The mean survival with patients who would qualify for this is six months without a transplant, Hall says.
“There’s now a portable driver they can convert to so they can leave the hospital,” she said. “It’s like dragging a carry on luggage on wheels.”
The first successful patient received the TAH in early February. On Feb. 29, he received the heart transplant. Baylor University Medical Center officials say it’s the first time a patient has received a total artificial heart in North Texas and survived until the transplant. Previously, they had to travel to Houston to have the operation done.
“It’s uncommon, but there are a few patients where they don’t have any other option,” says Dr. Themistokles Chamogeorgakis, the heart surgeon who is leading the initiative. “It is a life saving solution for those patients.”
Between 3 and 5 percent of all transplant patients qualify for a total artificial heart, Chamogeorgakis says. And Bryan Tyo was one of those. The McKinney resident suffered a severe heart attack in January, which damaged his heart to the extent that repair surgery and other devices wouldn’t have helped. A total artificial heart was his only chance for survival. The 13.5 pound device kept him going until February 29, when surgeons transplanted his heart. He’s recovered and is now back at home.
Dr. Jack Copeland, the co-founder of SynCardia Systems, Inc., the medical device company that makes the TAH, advised the surgeons during the implantation. Baylor will have an expert in the operating room for the next two or three procedures for training purposes. The TAH has high marks in clinical studies. One, published in The New England Journal of Medicine, found that recipients of a total artificial heart had a 79 percent transplant rate—the highest of any approved heart device. Copeland was the principal investigator on that study.
Nationwide, there have been more than 1,350 implanted in patients. Baylor University Medical Center is the state’s third hospital to offer the TAH. It joins Memorial Hermann at the Texas Medical Center and the Methodist DeBakey Heart & Vascular Center, both in Houston.
“We have full coverage and a comprehensive approach for heart failure problems and can provide any type of treatment based on their pathology, we have the full repertoire and plenty of solutions,” Chamogeorgakis says. “So any kind of heart failure problem for destination therapy or bridge to transplantation, even treatments that are being tested at the experimental level.”