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Health See other Health Articles Title: Cow heart sac key to clot-free artificial heart Bioprosthetic Total Artificial Heart Implanted in First 2 Patients NEW YORK (Reuters Health) - A new bioprosthetic total artificial heart has been successfully implanted in two male patients with end-stage heart disease, researchers from France report. Total artificial hearts (TAHs) have been around for more than four decades, but thromboembolic events related to their use remain a major issue. Dr. Alain Carpentier from Paris Descartes University, France, and colleagues developed their CARMAT TAH (C-TAH) with the reduction of thromboembolic and hemorrhagic complications in mind. They lined components in contact with blood with bovine pericardial tissue chemically treated with glutaraldehyde to achieve long-term tolerance and hemocompatibility. They implanted the devices in a 76-year-old man with severe biventricular failure (left ventricular ejection fraction (LVEF), 20%) resulting from dilated cardiomyopathy (patient 1) and a 68-year-old man with end-stage biventricular failure due to dilated cardiomyopathy (LVEF, 15%) (patient 2). Patient 1 was walking by postoperative day 14, but his postoperative course was complicated by periprosthetic clots (day 23), pneumonia (day 27), and bleeding from a gastric ulcer (day 41). While enjoying time with his family, he died suddenly on day 74. The prosthesis had arrested as a result of failure of an electronic component. Patient 2 spent his first 13 postoperative days in intensive care because of postoperative renal failure requiring transient hemodialysis. Otherwise, his postoperative course was uneventful except for a pericardial effusion at day 45. He died on day 270 as a result of device failure. Neither patient experienced any thromboembolic complications, even after a 50-day anticoagulant-free period in patient 1, according to the July 29 online report in The Lancet. "This initial experience with C-TAH in two patients provides an optimistic appraisal of the value of using bioprosthetic materials in the construction of artificial hearts and devices," the researchers concluded. "Since this report has been accepted for publication, a third patient has been implanted successfully and is now being rehabilitated close to his hometown, 104 days postoperatively." "Although the C-TAH does not have hematocompatibility constraints, it has the disadvantage of all TAH systems compared with any ventricular assist device (VAD), namely the absence of a biological back-up pump, the weakened but remaining native heart," Dr. Alexander Stepanenko and Dr. Friedrich Kaufmann, from Deutsches Herzzentrum Berlin, Germany, wrote in a related commentary. "Any technical failure causing a pump-stop will inevitably lead to death, as in both patients in this study." "The advantages of a more hemocompatible device need to be weighed against the potentially limited lifespan because of mechanical complexity, the lack of fail-safe functionality, and the limited applicability due to its size," the editorial concluded. "Only if the C-TAH shows extreme longevity of its components can we imagine it becoming a true alternative to VAD systems." Dr. Carpentier is cofounder of CARMAT SA, which provided funding for the study, employed three of the authors, and provided consulting fees to six of the authors. Dr. Carpentier did not respond to a request for comments. SOURCE: http://bit.ly/1gN2Oxv and http://bit.ly/1MPW6Uu Lancet 2015. Related Drugs & Diseases Primary and Secondary Prevention of Coronary Artery Disease Risk Factors for Coronary Artery Disease Imaging in Coronary Artery Disease Post Comment Private Reply Ignore Thread
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