When the TAH patient has stabilized and no longer needs to be in the ICU, the patient is transferred to a step-down unit. Certain SynCardia TAH-t patients may be considered for transition to the Freedom® portable driver system (SynCardia Systems, Inc, Tucson, AZ), which was designed to allow TAH-t patients to be discharged home. It has approval from the FDA, Health Canada, and European Union. Weighing approximately 6 kg and packaged in a wearable backpack or bag, the Freedom® portable driver liberates the patient from being tethered to a larger pneumatic console (Figures 7 and 8). The Freedom® portable driver display shows beat rate, left ventricular fill volume, and cardiac output, but only the beat rate may be adjusted.108,109 Preliminary experiences have shown that it is possible to safely discharge a TAH-t patient home with a portable driver, allowing for improved quality of life and potential reduction in medical costs while awaiting heart transplantation.109–111
Despite advancements in the medical management of heart failure, the demand for heart transplantation continues to be a growing burden worldwide. The use of mechanical circulatory support has become more prevalent, and clinician familiarity with devices has become more significant. Several TAHs have been developed over the past 60 years, but currently the SynCardia TAH-t is the only 1 being used. The SynCardia TAH-t has shown that it can be an effective bridge to heart transplantation in patients with biventricular failure. With the Freedom® portable driver, certain TAH-t patients may even be discharged home to wait for a transplant offer as an outpatient. TAH technology will continue to evolve with hope that it may offer a more definitive treatment for patients with heart failure in the near future.
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