Interim heart replacement with a mechanical device: an adjunct to management of allograft rejection.
Acute heart rejection; unresponsive to immunosuppressive therapy, results in cardiogenic shock and death. In the absence of another donor heart, a total artificial heart can be used as a suitable bridging device to re-transplantation. A thirty-three year-old man rejected his allograft forty-eight hours after transplantation. A total artificial heart was used for eleven hours until another donor heart became available and was transplanted. During the bridging period, the hemodynamic performance of the mechanical prosthesis was satisfactory. The patient died forty-eight hours after re-transplantation of donor right heart failure due to pulmonary edema. This edema was felt to be related to the long periods of cardiopulmonary bypass. This unique experience illustrates the need for a prompt decision to proceed with cardiac replacement, avoiding long periods of cardiopulmonary bypass, the need for a suitable mechanical device availability, technical expertise in device implantation and allograft transplantation.