Purpose: Heart failure patients with severe biventricular failure who are candidates for heart transplant are considered for Total Artificial Heart (TAH) support. These patients may be in cardiogenic shock (Intermacs 1) and it is unclear as to whether these patients benefit from this newer technology. In the current literature, there is contention as to whether cardiogenic shock or Intermacs 1 patients should have any intervention performed due to high risk of mortality. We sought to evaluate our patients who have undergone TAH placement and outcomes based on their severity of illness/Intermacs level.

Methods: Between 2010 and 2014, we assessed 33 patients who underwent TAH placement. Patients were divided according to their Intermacs level at the time of TAH implantation. This included Intermacs 1 (n=13), Intermacs 2 (n=11) , and Intermacs ≥3 (n=9). Outcomes included 6 month device success (defined as survival and/or bridged to transplant), 6 month actuarial freedom from stroke, gastrointestinal bleed, infection, and renal failure (defined as need for dialysis).

Results: There was a significant decrease in survival in the Intermacs 1 group compared to the Intermacs 2 and ≥3 groups (log-rank p=0.013, see table). There is no significant difference in complications among the 3 groups.

Conclusion: Patients with severe biventricular heart failure who are Intermacs 1 have significantly lower device success questioning the efficacy of this intervention for these patients. Determining a subset of Intermacs 1 patients who may have a higher chance of survival is currently underway.

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