Feasibility of Outpatient Hemodialysis for Patients with Total Artificial Heart: A Case Series

Total artificial hearts (TAH) are used in patients with end-stage heart failure as a bridge-to-transplant. AKI is a common postoperative complication associated with TAH implant. Patients requiring temporary dialysis are denied implantation of TAH due to the inability to provide outpatient (OP) dialysis in the long term. Here we discuss four cases of TAH patients from a single center who were successfully maintained on OP hemodialysis (HD). All four patients were implanted with a 70cc SyncardiaTM TAH for NICM. Two patients were implanted as bridge-to-transplant (BTT); one received a heart/kidney transplant and the other received a heart transplant. Two patients were implanted as destination therapy; one was maintained on OP HD until end-of-life, and the other received a heart transplant after becoming transplant eligible. These cases confirm that OP HD is a feasible option for TAH patients with post-implant chronic renal dysfunction provided that the dialysis centers are trained and supported by the implanting program.