Inpatient cardiac rehabilitation after implantation of a total artificial heart (Aeson device CARMAT) in case of ventricular septal defect after infarction

Abstract

Background: Post-infarction ventricular septal defect (VSD) is a rare but life-threatening complication of myocardial infarction, in severe cases needing heart transplantation. The Aeson Total Artificial Heart (TAH), a bioprosthetic device designed to replace both ventricles, offers an alternative for patients unsuitable for conventional therapies.

Case summary: A 69-year-old male presented in cardiogenic shock following an inferior wall ST-elevation myocardial infarction complicated by a large VSD. Initial support included extracorporeal life system. Surgical repair was unfeasible due to the defect's size and proximity to the atrioventricular valve, leaving insufficient rim for septal reconstruction. Total artificial heart implantation was the only viable option, used as bridge-to-decision therapy given the patient's advanced age. Post-operative recovery was prolonged, but the patient was successfully transferred to an inpatient rehabilitation facility, where structured physiotherapy, endurance, resistance, and mobility training led to significant functional improvement. Close collaboration with a mechanical circulatory support perfusionist resolved recurring TAH alarms related to intraventricular pressure and communication issues adapting the diuretic and antihypertensive medication. The patient was discharged home in stable condition, achieving substantial physical recovery and independence in managing the device.

Discussion: The Aeson TAH proved to be a safe and effective therapy, in particular, as bridge-to-decision therapy in this complex case of post-infarction VSD. Inpatient cardiac rehabilitation played a pivotal role in optimizing physical recovery, managing device-related challenges, and preparing the early transition to an independent living. This case highlights the potential of advanced bioprosthetic solutions and the benefits of a structured rehabilitation system in managing severe cardiac conditions. Further research is needed to evaluate the long-term outcomes and broader applicability of the Aeson TAH.

Keywords: AESON CARMAT; Cardiac rehabilitation; Case report; Myocardial infarction (MI); Total artificial heart (TAH); Ventricular septal rupture (VSR).

Figure 1

Description of Aeson® components, adapted from the official clinician manual and the ‘2022 Universal Registration Document’.^, Images reproduced with permission from CARMAT SA. (A) Schematic representation of the functional mechanism of the Aeson Total Artificial Heart. (B) Illustration of the Aeson Total Artificial Heart system, including the external driveline. (C) Visualization of the surgical connection between the Aeson Total Artificial Heart and the atria.

Figure 2

Chest X-ray showing the Aeson® CARMAT Total Artificial Heart, the red star marks the main part of the prosthesis, which contains two micropumps, embedded electronics, and sensors that enable the device to mimic natural heart function through auto-regulated, pulsatile blood flow. The blue star indicates the connection between the atrial flanges and the atrial interface following ventricular removal. The green star marks the pulmonary and aortic valves. The purple star denotes the driveline.

Figure 3

(A) Computed tomography of the Aeson® CARMAT Total Artificial Heart device. The red star marks the main part of the prosthesis, which contains two micropumps, embedded electronics, and sensors. The yellow star indicates the connection between the atrial flanges and the atrial interface following ventricular removal. The green star marks the pulmonary and aortic valves. The blue star denotes the driveline. (B) Due to acoustic shadowing from the prosthesis, transthoracic echocardiography is limited, allowing only assessment of the inferior vena cava to estimate volume status.

Figure 4

Screenshot of the Aeson® Total Artificial Heart monitor display showing real-time data on pressures and flows. The green box displays the average flow in the left and right chambers, along with the heart rate. Between the blue lines, systolic and diastolic pressures, as well as stroke volumes for both chambers, are shown. The red box highlights the five prosthesis settings available in automatic mode, including inflow and outflow pressures. On the right side, the blue star marks the left ventricular pressure, while the red star indicates the right ventricular pressure.