Technical solution for repair of ruptured cannula in patients supported with a total artificial heart
J Medenica, N Simic, N Ristic, B Stosic, M Obradovic, S Borovic, M BojicAbstract
Background
Total artificial heart (TAH) implantation is intended as a temporary bridge to heart transplantation. In countries with extremely limited donor availability, TAH support often becomes prolonged, increasing the risk of device-related technical complications.
Purpose
To present one of our technical solutions for surgical repair of a ruptured cannula and to analyze the clinical context associated with this complication during prolonged TAH support.
Methods
Between 2017 and 2024, 43 patients underwent TAH implantation at a single tertiary center. The indication was end-stage heart failure in the setting of severe donor shortage in Serbia (approximately 2 donors per million population, non-Eurotransplant country). At the time of analysis, 19 patients with more than 2 years after TAH implantation were alive on TAH support and constituted the study cohort. Clinical characteristics and cannula-related technical complications were retrospectively analyzed. Cannula repair involved replacement of the ruptured segment using a matching PVC tubing segment of appropriate length (4,0–5,0 cm), fitted with compatible connectors to restore system integrity.
Results
Dilated cardiomyopathy was the predominant etiology among living patients, followed by ischemic cardiomyopathy. Most patients were in advanced clinical status preoperatively, with NYHA class IV and INTERMACS profiles 1–3. Cannula rupture was the most frequent major technical complication, occurring in 6 of 19 patients (31.6%) mostly 6 months after TAH implantation. All patients underwent successful cannula repair without immediate procedure-related mortality. The cannulas used with the SynCardia Systems Total Artificial Heart are composed of polyvinyl chloride (PVC) tubing, which may harden and become brittle over time, particularly with repeated exposure to cleaning agents, predisposing them to rupture.
Conclusion
In low-donor healthcare systems, prolonged TAH support is associated with a high technical burden. A standardized technical approach to cannula repair is feasible and may contribute to safer long-term total artificial heart support in patients awaiting transplantation.Ruptured cannulaFor image description, please refer to the figure legend and surrounding text.Repaired cannulaFor image description, please refer to the figure legend and surrounding text.