Total artificial heart and physical therapy management.

PURPOSE: To describe the total artificial heart (TAH) device as a bridge to heart transplantation (BTT), and related physical therapy management, while comparisons to left ventricular assist devices (LVAD) are made.

SUMMARY: The SynCardia CardioWest Temporary TAH System is the only TAH approved by the Food and Drug Administration (FDA), Health Canada and Consultants Europe (CE) for BTT. CardioWest implantation involves cardiectomy thus avoiding pulmonary hypertension, right heart failure, inotropic or anti-arrhythmic agents, myocardial and valve related problems. CardioWest has a fixed beat rate and cardiac output is dependent upon venous return and preload. Both TAH and LVADs are adaptive with exercise, increasing cardiac output during activities, allowing for conditioning to occur peripherally. Left ventricular assist devices have portable drivers permitting discharge home, while the CardioWest's large driver console necessitates inpatient therapy. Exercise progression, positioning, and monitoring of exercise intolerance are similar with LVAD and TAH. Ventricular fill volumes in TAH dictate cardiac output and require close attention. Cardiectomy in TAH prevents electrocardiography, telemetry, and native pulse rate monitoring.

CONCLUSION

While mechanical differences exist between TAH and LVAD, physical therapists can provide evidence-based treatment for patients with TAH using previously established guidelines for patients with heart failure and mechanical circulatory support.