IJCS | Volume 32, Nº1, January/ February 2019

90 1. Copeland JG. SynCardia Total Artificial Heart: update and future. Tex Heart Inst J. 2013;40(5):587-8. 2. Copeland JG, Smith RG, Arabia FA, Nolan PE, Sethi GK, Tsau PH, et al; CardioWest Total Artificial Heart Investigators. Cardiac replacement with a total artificial heart as a bridge to transplantation. N Engl J Med. 2004;351(9):859-67. 3. Wever-Pinzon O, Drakos SG, McKellar SH, Horne BD, CaineWT, Kfoury AG, et al. Cardiac recovery during long-term left ventricular assist device support. J Am Coll Cardiol. 2016;68(14):1540–53. 4. Torregrossa G, Anyanwu A, Zucchetta F, Gerosa G. SynCardia: the total artificial heart. Ann Cardiothorac Surg. 2014;3(6):612–20. 5. Smith L, Farroni J, Baillie BR, Haynes H. Heart transplantation an answer for end-stage heart failure. Crit Care Nurs Clin North Am. 2003;15(4):489-94. 6. Copeland JG, Copeland H, Gustafson M, Mineburg N, Covington D, Smith RG, et al. Experience with more than 100 total artificial heart implants. J Thorac Cardiovasc Surg. 2012;143(3):727-34. 7. Kirklin JK, Naftel DC, Pagani FD, Kormos RL, Stevenson LW, Blume ED, et al. Seventh INTERMACS annual report: 15,000 patients and counting. J Heart Lung Transplant. 2015;34(12):1495-504. 8. Yap SC, Ramjankhan F, Muslem R, de Jonge N, Kirkels HJ, Akin S, et al. Ventricular arrhythmias in patients with a continuous-flow left ventricular assist device. J Am Coll Cardiol. 2016;68(3):323-5. 9. Garan AR, Yuzefpolskaya M, Colombo PC, Morrow JP, Te-Frey R, Dano D, et al. Ventricular arrhythmias and implantable cardioverter- defibrillator therapy in patients with continuous-flow left ventricular assist devices: need for primary prevention? J Am Coll Cardiol. 2013;61(25):2542-50. References Rico et al. Terminal AHF due to electrical storm:TAH orVAD Int J Cardiovasc Sci. 2019;32(1)87-90 Case Report high costs for the patient, which are not usually covered by insurance companies. 7 The total artificial heart is a pneumatic, biventricular, orthotopic, pulsatile device that displaces 400 ml per cycle 7 (see Figure 1). Blood flow follows the normal physiology of the human heart, with flow rates of up to 9.5 L/min (barely turbulent). The device generated a Starling-like response by matching cardiac output with venous return and balancing blood flow between both ventricles. 8 One of the main challenges facing the widespread use of TAH was the lack of clear indications. As far as we know, there are no clinical trials on course aiming to evaluate indications and outcomes of this device. The indications for TAH implantation are a matter of controversy. However, the FDA established inclusion and exclusion criteria, as shown in Table 1. Another important limiting factor is the short experience with TAH that makes this device a complex option for acute ill patients. Most surgeons would need proctor’s help prior to implantation. Also the experience curve would have a slow-linear slope, making this device an option exclusively for highly specialized cardiovascular centers. 9 Conclusion Total artificial heart is a novel device that achieved more than expected benefits, particularly for BTT patients with right ventricle dysfunction and recalcitrant ventricular arrhythmias in need of mechanical support. However, no multicenter clinical trials have been conducted to assess its efficacy or safety in comparison with other assist devices. Short-experience still represents a hindrance for the device to be deployed. The lack of clear indications supported by international guidelines makes the use of these devices a skeptical decision that should only be made by experts. Author contributions Conception and design of the research: Rico JS, Prasad M. Acquisition of data: Rico JS, Prasad M. Analysis and interpretation of the data: Rico JS, Prasad M. Statistical analysis: Rico JS, Prasad M. Writing of the manuscript: Rico JS, Arango-Isaza D, Saldarriaga C. Critical revision of the manuscript for intellectual content: Rico JS, Arango-Isaza D, Prasad M, Saldarriaga C. Supervision / as the major investigador: Rico JS. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associated with any thesis or dissertation work. This is an open-access article distributed under the terms of the Creative Commons Attribution License