The University of Rochester Medical Center cardiac transplant team has replaced a 49-year-old man’s heart with a total artificial heart, introducing a new, life-sustaining treatment option for the most critically ill patients with end-stage heart failure.
Gaetano Orlando received a SynCardia temporary Total Artificial Heart on April 4 by a team of cardiac surgeons and physicians from the URMC Artificial Heart Program.
“This is tremendous technology that can have a dramatic effect on patients who are experiencing advanced heart failure,” said H. Todd Massey, M.D., surgical director of the URMC Artificial Heart Program who led the surgery. “For this patient, it was the only option to keep him alive until a donor heart could become available.”
The total artificial heart is a bridge to transplant for patients who suffer from end-stage biventricular heart failure, a condition in which both sides of the heart become weakened and cannot pump blood adequately throughout the body. More than 1,000 have been used in patients worldwide to date.
URMC is one of 30 sites in the country, and one of just two locations in New York, to offer this life-saving technology. Columbia-New York Presbyterian Hospital in New York City is the only other location in the state.
To implant the SynCardia device, surgeons remove the left and right ventricles and valves of the heart, leaving the left and right atria, aorta and pulmonary artery intact.
Although transplantation is still the treatment of choice for those with end-stage heart failure who do not respond to other medical or surgical treatments, a shortage of donor organs limits the option of transplantation for many, Massey said.
“This is another option in our growing arsenal of devices used as a bridge to transplant. The advances in technology and care in the past 20 years have allowed us to extend the life of many more patients with heart failure,” said transplant cardiologist Leway Chen, M.D., M.P.H., medical director of the URMC Artificial Heart Program and the URMC Program in Heart Failure and Transplantation.
Orlando is a retired hockey player, whose career included time with the Buffalo Sabres and Rochester Americans, as well as the Italian national team in the 1994 and 1998 Olympics.
There are more than 3,100 people waiting for heart transplants in the United States, according to the United Network for Organ Sharing. Currently URMC has 32 patients awaiting transplant at home or in the hospital.
“This can be a life-saving measure for patients whose only other option is an immediate heart transplant,” Massey said. “The total artificial heart leads to recovery of organ function in the most critically ill patients, allowing for a heart transplant when the patient is more stable - which ultimately helps achieve better outcomes following transplantation.”
Transplant cardiologist Eugene Storozynsky, M.D., Ph.D., has cared for Orlando since he was diagnosed with sarcoidosis, a rare form of heart failure that affects all four chambers of the heart. The need for a new heart came about quickly and without an available donor heart, doctors implanted the total artificial heart. Storozynsky said Orlando will be hospitalized for several weeks and has been added to the heart transplant waiting list.
The SynCardia temporary Total Artificial Heart is powered with air and vacuum provided by a pneumatic driver that weighs more than 400 pounds, requiring patients to remain in the hospital while on the device. As the patient recovers, he may be able to use a smaller driver to accommodate life at home.
“While we hope to perform a transplant as soon as the patient is ready, he can live with an artificial heart for a long time,” Massey said. “We hope to be able to provide our patient the portable driver so that he can resume a reasonably normal lifestyle and activities until a donor heart becomes available.”
The longest that a patient has been supported by the total artificial heart as a bridge to successful heart transplantation is 46 months, according to SynCardia, the device maker.
The total artificial heart is vastly different technology than other heart pumps such as the left ventricular assist devices (LVAD) where the heart remains inside the patient. Massey has implanted more than 1,000 LVADs and other heart pumps in URMC patients.
The URMC Heart & Vascular Center is the region’s most comprehensive program, providing multidisciplinary care from the first warning signs of heart disease to sub-specialized treatments such as the SynCardia implantation. The Program in Heart Failure and Transplantation and the Artificial Heart Program are dedicated to providing state-of-the-art care and cutting-edge technology to extend survival.