(< 35% of LVAD patients are free of these com­plications at one year), are significantly reduced with this device. Certainly, it will help mitigate right heart failure associated with the poor sur­vival seen with BIVAD currently in use.

of intervention is often the key to a success­ful outcome. Preop evaluation of advanced HF candidates for a TAH includes a thorough his­tory looking specifically for the severity of advanced HF to satisfy the need for this device and to ensure that they are not suitable candi­dates for an LVAD, revascularization, medical management, or bridge directly to HTx with temporary percutaneous VADs [33]. It is criti­cal that the patient be evaluated for underlying malignancies, bleeding or coagulopathies, renal, hepatic, vascular, and pulmonary diseases that would markedly increase morbidity and mortal­ity. Other diagnostic studies typically required during the evaluation process include an echocardiogram, left/right heart catheterization, cardiopulmonary exercise test, gastrointestinal work-up, renal assessment, coagulation parame­ters, history of heparin-induced thrombocytope­nia /bleeding/thrombotic, genetic complications along with caregiver support, patient sophistica­tion and acceptance of technology and insurance coverage (i.e., MediCal does not cover TAH in California).

these patients. In fact, due to the more favora­ble viscosity at lower hemoglobin, running lev­els of 7–9 with good oxygen delivery d/t higher flows would not be unusual. Inotropes are typi­cally unnecessary, although IV vasoconstrictors are often utilized to maintain systemic vascu­lar tone in vasoplegic conditions. Renal failure perioperatively is also a common complication requiring CRRT/HD, but with reasonable per­fusion pressure and avoidance of nephrotoxic agents, many patients will demonstrate signifi­cant recovery over time. The usual attention to good pulmonary toilet and airway protection is important. Systemic anticoagulation is begun as soon as hemostasis is achieved, usually with chest tube output < 20 cc/hr in the form of IV heparin on postop day 2–4 (without bolus) and subsequently transitioned to PO coumadin with typical INR goal of 2–3. We have often utilized the thromboelastogram to gain a better under­standing of the clotting cascade and platelet aggregation pathway. This appears particu­larly enlightening when there is a discordance between the INR and clinical coagulation/bleed­ing tendencies. Ambulation around the unit with a Companion 2 pneumatic driver system is often possible within the first week. Transition to the Freedom II portable driver usually occurs on the floor prior to discharge. Education of patients and family members is an ongoing process. The typical period of postoperative management prior to discharge is in the range of 3–4 weeks [34].