Translation of First North American 50 and 70 cc Total Artificial Heart Virtual and Clinical Implantations: Utility of 3D Computed Tomography to Test Fit Devices

• Published in: Artificial organs 2017-08, Vol.41 (8), p.727-734
• Main Authors: Ferng, Alice S., Oliva, Isabel, Jokerst, Clinton, Avery, Ryan, Connell, Alana M., Tran, Phat L., Smith, Richard G., Khalpey, Zain
• Format: Article
• Language: English
• Subjects: 3D surgical modeling; Adult; Artificial organs; Atria; Chest; Complications; Computation; Computed tomography; Computer simulation; Computerized tomography; Diaphragm; Diaphragm (anatomy); Female; Heart; Heart Failure - surgery; Heart, Artificial; Humans; Image reconstruction; Imaging, Three-Dimensional - methods; Implantation; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Middle Aged; Modelling; Patients; Prosthesis Implantation - methods; Sizing; Surgery; Surgical implants; Thorax; Three dimensional models; Tomography; Tomography, X-Ray Computed - methods; Total artificial heart; United States; Virtual implantation; Young Adult
• ISSN: 0160-564X; 1525-1594
• DOI: 10.1111/aor.12854

Since the creation of SynCardia's 50 cc Total Artificial Hearts (TAHs), patients with irreversible biventricular failure now have two sizing options. Herein, a case series of three patients who have undergone successful 50 and 70 cc TAH implantation with complete closure of the chest cavity utilizing preoperative “virtual implantation” of different sized devices for surgical planning are presented. Computed tomography (CT) images were used for preoperative planning prior to TAH implantation. Three‐dimensional (3D) reconstructions of preoperative chest CT images were generated and both 50 and 70 cc TAHs were virtually implanted into patients' thoracic cavities. During the simulation, the TAHs were projected over the native hearts in a similar position to the actual implantation, and the relationship between the devices and the atria, ventricles, chest wall, and diaphragm were assessed. The 3D reconstructed images and virtual modeling were used to simulate and determine for each patient if the 50 or 70 cc TAH would have a higher likelihood of successful implantation without complications. Subsequently, all three patients received clinical implants of the properly sized TAH based on virtual modeling, and their chest cavities were fully closed. This virtual implantation increases our confidence that the selected TAH will better fit within the thoracic cavity allowing for improved surgical outcome. Clinical implantation of the TAHs showed that our virtual modeling was an effective method for determining the correct fit and sizing of 50 and 70 cc TAHs.