Elsevier

Transplantation Proceedings

Volume 48, Issue 1, January–February 2016, Pages 279-281
Transplantation Proceedings

Recent Advances in Transplantation
Case report
Total Artificial Heart as Bridge to Heart Transplantation in Chagas Cardiomyopathy: Case Report

https://doi.org/10.1016/j.transproceed.2015.12.017Get rights and content

Highlights

  • This is the first report of the use of a TAH as a bridge to HTx in a patient with advanced HF and a cardiomyopathy due to CD, an increasingly recognized cause of cardiomyopathy in the United States and other countries outside of Central and South America, where it is endemic.

  • CC may be considered a relative contraindication to HTx due to potential reactivation of the causative organism (T cruzi) by immunosuppressive therapy.

  • Removal of the organ most affected by the disease process (the heart) as a consequence of TAH insertion, as opposed to insertion of a ventricular assist device, may reduce the infectious burden of the causative organism.

  • A patient with CD and severe biventricular dysfunction, who had mechanical circulatory support with a TAH for more than 6 months, followed by successful orthotopic HTx and treatment with benznidazole for 3 months, is described.

  • The patient had no evidence of recurrent disease in the transplanted heart by endomyocardial biopsy up to 1 year post-transplantation, and remains alive more than 30 months after insertion of a TAH and 24 months after HTx.

Abstract

Chagas disease (CD) is becoming an increasingly recognized cause of dilated cardiomyopathy outside of Latin America, where it is endemic, due to population shifts and migration. Heart transplantation (HTx) is a therapeutic option for end-stage cardiomyopathy due to CD, but may be considered a relative contraindication due to potential reactivation of the causative organism with immunosuppression therapy. The total artificial heart (TAH) can provide mechanical circulatory support in decompensated patients with severe biventricular dysfunction until the time of HTx, while avoiding immunosuppressive therapy and removing the organ most affected by the causative organism. We report herein a patient with CD and severe biventricular dysfunction, who had mechanical circulatory support with a TAH for more than 6 months, followed by successful orthotopic HTx and treatment with benznidazole for 3 months. The patient had no evidence of recurrent disease in the transplanted heart based on endomyocardial biopsy up to 1 year post-transplantation, and remains alive more than 30 months after insertion of a TAH and 24 months after HTx.

Section snippets

Case Report

A 53-year-old woman (body surface area [BSA] 1.61 m2) had a dilated cardiomyopathy, HF, ventricular ectopy, prior pacemaker-cardioverter-defibrillator placement, atrial fibrillation, hypothyroidism, hypertension, hyperlipidemia, and diabetes. The patient was born in a country in Central America where CD was endemic, and immigrated to the United States. She developed decompensated HF. Serologies (immunoglobulin [Ig]G) for T cruzi were positive in July 2011 (>1:512) and October 2012.

The patient

Discussion

CD is a major cause of end-stage cardiomyopathy in Central and South America, and CC is the third leading indication for HTx in Brazil [8]. This cause of cardiomyopathy is having a serious economic impact on the United States, Europe, and other areas outside of Central and South America. In a 2009 publication, it was estimated that there were 300,000 persons with chronic CD in the United States, resulting in 30,000–45,000 cases of CC [9]. The cost of treatment in the United States is estimated

Cited by (0)

No funding was provided for this study. F. Arabia, MD, is a trainer for Syncardia System. The other authors have no conflicts of interest to disclose.

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