Carmat Total Artificial Heart as a Bridge to Transplant in Patients With Advanced Heart Failure

Prior treatment

• Known intolerance to anticoagulant or antiplatelet therapies or known Heparin Induced Thrombocytopenia.

Other illness

• Absolute contra-indication for heart transplant
• History of severe Chronic Obstructive Pulmonary Disease or severe restrictive lung disease with FEV1/FVC \<0.7 and FEV1\<50% predicted.
• Recent active blood stream infection confirmed by a positive hemoculture within 48 hours.
• Hemodynamically significant peripheral vascular disease assessed by clinical exam.
• Illness, other than heart disease, that would limit survival to less than 2 years.
• Irreversible cognitive dysfunction, psycho-cognitive disabilities, psycho-social issues or psychiatric disease, likely to impair compliance with the study protocol and TAH management that in the opinion of the investigator could interfere with the ability to manage the therapy (i.e. non-compliance to heart failure therapy, uncontrolled diabetes, mental health issue, etc.).

Lab values

• Coagulopathy defined by platelets \< 100G/l or INR ≥ 1.5 not due to anticoagulant therapy.
• Severe end-organ dysfunction as per the following criteria:
  • Total bilirubin \> 45 µmol/l (2.65 mg/dl) or cirrhosis evidenced by ultrasound, IRM and positive biopsy
  • GFR \< 30ml/min/1.73m2 (with no hemodialysis)

Age

• Pregnancy or breast feeding (woman in childbearing age will have to show negative pregnancy test).

Other

• Existence of any ongoing non-temporary mechanical circulatory support
• Existence of any ongoing peripheral mechanical circulatory support such as ECMO, Impella (all types), IABP with a support duration \> 21 days
• Patient intubated and unconscious; or intubated and not awake
• Known thrombophilia (Antithrombin III, protein C or S deficiency) or any recurrent venous thromboembolic events requiring long term curative oral anticoagulation.
• Cerebrovascular accident \< 3 months or symptomatic (Rankin score \>1; Glasgow score \< 14) or a known \> 80% carotid stenosis.
• Known abdominal or thoracic aortic aneurysm \> 5 cm that has not been treated.
• Documented amyloid light-chain (AL amyloidosis).
• Patient is currently enrolled or has participated in the last 30 days in another therapeutic or interventional clinical study that is likely to confound the study results or affect the study.

• Patient 18 years or older
• Patient in the waiting list for heart transplant or temporarily contraindicated for heart transplant
• On inotropes or cardiac Index (CI) \< 2.2 L/min/m2
• On Optimal Medical Management as judged by the investigator based on current Heart Failure practice guidelines (ESC/HAS)
• Eligible to biventricular Mechanical Circulatory Support according to one of the following category:
  • Biventricular failure with at least two of the following hemodynamic/ echocardiographic measurements implying right heart failure:
  • RVEF ≤ 30% or FAC \< 35%
  • RVSWI ≤ 0.25 mmHg\*L/m2
  • TAPSE ≤ 14mm
  • RV-to-LV end-diastolic diameter ratio \> 0.72
  • CVP \> 15 mmHg or persistence of echographic and/or biological signs of hepatic congestion
  • CVP-to-PCWP ratio \> 0.63
  • PAP index \<2
  • Tricuspid insufficiency grade 4
  • Treatment-refractory recurrent and sustained ventricular tachycardia or ventricular fibrillation in the presence of untreatable arrhythmogenic pathologic substrate.
  • Heart failure due to restrictive or constrictive physiology (e.g., hypertrophic cardiomyopathy, cardiac amyloidosis / senile or other infiltrative heart disease)
• Anatomic compatibility confirmed using 3D imaging (CT-scan) and by the screening committee (for Cohort 1).
• Patient's affiliation to health care insurance
• Patient has signed the informed consent.